Gender, Relationship Dynamics, and Vertical Transmission of HIV in Delhi

This chapter focuses on gendered relationship dynamics among heterosexual married couples living with HIV in Delhi, India, and their experience of preventing vertical transmission. India’s prevention of mother-to-child transmission (PMTCT) program provides testing and treatment to women during antenatal care (ANC). While several studies have examined gender inequality in the context of HIV prevention and PMTCT, less is known about how various aspects of couples’ gendered relationship dynamics act as facilitators and barriers to the same. Building on sociologist Raewyn Connell’s theory of gender and power and the relational gender theory, this chapter used data from a qualitative, in-depth interview study with eleven couples and one woman whose husband did not consent to participate. Using a modified grounded theory approach to data analysis, the findings are structured based on the couples’ seronature (seroconcordant, serodiscordant, or unknown) and the timing of HIV testing (before ANC or during ANC). Across all categories of couples, the desire for children is a crucial determinant of adherence to HIV prevention guidelines. Relative power among couples before HIV diagnoses can shape decision-making around condom use, and mutual respect and communication can positively affect treatment adherence. Moreover, societal gender norms that expose women to violence and discrimination may affect how HIV-positive women experience HIV and PMTCT. These findings have implications for intimate relationships between heterosexual couples, an important site for HIV prevention and control efforts. The implications are discussed through the lens of strengthening PMTCT in India.