AIDS and Behavior

, Volume 22, Issue 4, pp 1273–1287 | Cite as

Couple Relationship Functioning as a Source or Mitigator of HIV Risk: Associations Between Relationship Quality and Sexual Risk Behavior in Peri-urban Uganda

  • Allison Ruark
  • Phoebe Kajubi
  • Sam Ruteikara
  • Edward C. Green
  • Norman Hearst
Original Paper


Despite evidence that a greater focus on couples could strengthen HIV prevention efforts, little health-related research has explored relationship functioning and relationship quality among couples in Africa. Using data from 162 couples (324 individuals) resident in a peri-urban Ugandan community, we assessed actor and partner effects of sexual risk behaviors on relationship quality, using psychometric measures of dyadic adjustment, sexual satisfaction, commitment, intimacy, and communication. For women and men, poor relationship quality was associated with having concurrent sexual partners and suspecting that one’s partner had concurrent sexual partners (actor effects). Women’s poor relationship quality was also associated with men’s sexual risk behaviors (partner effects), although the inverse partner effect was not observed. These findings suggest that relationship quality is linked to HIV risk, particularly through the pathway of concurrent sexual partnerships, and that positive relationship attributes such as sexual satisfaction, intimacy, and constructive communication can help couples to avoid risk.


HIV prevention Behavior change Couple relationship quality Concurrent sexual partnerships Alcohol 



This research was supported by a grant from the New Paradigm Fund, which supported A. Ruark, P. Kajubi and S. Ruteikara in designing and implementing the study. A. Ruark was supported in analysis of data and preparation of the manuscript by a post-doctoral fellowship through the National Institute on Drug Abuse (Grant Number T32DA13911). We thank the Ugandan facilitators and research assistants who participated in the intervention and research: Jamillah Naamala, Dativa Ssozi, Francis Ssozi, Marvin Katerega, Catherine Kiyenje, Josephine Nabukera, Ritah Nassaka, and Claire Seremba. Our sincere thanks to the participants and community leaders in Tebuyoleka Zone who made the research possible.

Compliance with Ethical Standards

Conflicts of interest

A. Ruark serves on the Advisory Board of the New Paradigm Fund (NPF) and received funding from NPF and from the National Institute on Drug Abuse (Grant Number T32DA13911). P. Kajubi and S. Ruteikara received funding from NPF. E. C. Green is President and Director of NPF. N. Hearst serves on the Board of Directors of NPF.

Ethical Approval, Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of MedicineBrown UniversityProvidenceUSA
  2. 2.Child Health and Development Centre, College of Health Sciences, School of MedicineMakerere UniversityKampalaUganda
  3. 3.All Saints CathedralKampalaUganda
  4. 4.Department of AnthropologyThe George Washington UniversityWashingtonUSA
  5. 5.Department of Family and Community Medicine, School of MedicineUniversity of California San FranciscoSan FranciscoUSA
  6. 6.MatielandSouth Africa

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