Abstract
Although medical advancements have turned HIV infection into a chronic disease and largely extended the life expectancies of people living with HIV (PLHIV), these patients and their seronegative spouses, especially those who reside in rural China, still confront adversities such as stigma and financial difficulties and suffer from poor well-being. Therefore, this thesis aimed to investigate the process of positive adjustment in this highly disadvantaged population.Guided by the systems framework of resilience, this thesis included both PLHIV and their seronegative spouses concurrently and used a two-wave longitudinal design to describe the systemic resilience process of HIV discordant couples. This thesis addressed the following knowledge gaps in the resilience research among HIV discordant couples: a) the dyadic data of the resilience process of HIV discordant couples were limited; b) the cross-level interplays of external and internal resources were neglected; c) contextual resources and their interactions with contextual risks were not adequately identified; and 4) the challenge to capture the holistic process of positive adjustment resulting from the multiplicity and complexity of the systemic perspective has yet to be overcome.
A total of 160 HIV discordant couples participated in the baseline survey, and 159 pairs completed the follow-up survey one year later. Based on this dataset, the author addressed the knowledge gaps above by investigating three research questions in three chapters.
In Chapter 2, the author addressed the roles of external and internal resilience resources and their cross-level interplays in the well-being outcomes using multiple group structural equational modeling. Results showed that better marital and family relationships, as important external resilience resources for HIV discordant couples, predicted better well-being of both PLHIV and seronegative spouses. Such positive effects were transmitted via individual resilience resources. Interestingly, the protective role of marital relationship was more direct and salient in seronegative spouses than in PLHIV.
In Chapter 3, the author examined the protective effect of couple identity, a putative fundamental contextual resilience resource for couples, and its interaction with HIV stigma, a prevalent contextual risk for HIV discordant couples, in the resilience process. Multilevel Modeling showed that a stronger couple identity predicted fewer depressive symptoms one year later at both the within- and between-couple level. Couple identity also predicted better self-rated health at the between-couple level. These effects were all moderated by HIV stigma, which diminished the protective role of couple identity on depressive symptoms and self-rated health.
In Chapter 4, the author applied person-oriented approach to HIV discordant couples to capture the holistic systemic resilience process by investigating the variations of dyadic adjustment in the couples and identifying the underlying configured patterns of multilevel risks and resources. Using Latent Profile Analysis, a person-oriented analysis protocol, three subgroups were identified within the sample of HIV discordant couples based on well-being of PLHIV and seronegative spouses. The first subgroup, labeled Maladapted Couples (36.5%), reported poor well-being in both PLHIV and the seronegative spouse. The second subgroup, labeled Resilient Couples (31.4%), was characterized by relatively good well-being in both partners. In the third subgroup, labeled
Maladapted PLHIV and Resilient Spouses (32.1%), the PLHIV showed poor well-being while the seronegative spouses demonstrated good well-being. This data-driven subgrouping was supported by validation with external physical and mental well-being measures. Further group comparisons identified distinct patterns of risks (including HIV stigma and financial difficulties) and resources (including individual resources and relational resources) of each subgroup.
This thesis advances resilience research in HIV discordant couples by employing the systems framework of resilience. Our findings provide dyadic data for the systemic resilience process of heterosexual HIV discordant couples in rural China. They also have substantive implications for future evidence-informed well-being promotion in this population. For example, service providers should consider improving relational resources, including marital relationship, family relationship, and couple identity, in discordant couples while also addressing HIV stigma. Moreover, the heterogeneity of dyadic adjustment and of patterns regarding risks and resources among HIV discordant couples also highlights the importance of tailoring interventions for distinct subpopulations.
| Date of Award | 14 Jan 2020 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Xiaonan Nancy YU (Supervisor) |