This segment of serodiscordant couples (SDC) is aware of their discordance (that one of them has HIV and the other does not) and have had their relationship disrupted by it in some way. They may be experiencing blame over who brought HIV into the relationship, disconnection around sex, and/or discouragement around conceiving. The discordance has been so disruptive for some that they now face the “discordance dilemma.” They see the avoidance of HIV transmission at odds with preserving their relationship. Other couples endure the discordance out of love and commitment, but the risk of HIV transmission is still disruptive, complicating the things they want and value in their relationship—intimacy and children. For Serodiscordant partners enrolling in PrEP is often perceived as more burdensome than helpful. Bringing up PrEP may resurface undesirable, negative feelings associated with the discordance, such as blame, guilt, and even violence. In visiting an HIV clinic, SDC risk disclosing their discordance to others, and partners without HIV risk being mislabelled as HIV positive. And taking PrEP may bring on undesirable stigma from others. Thus, when SDC compare PrEP to other HIV-prevention tools like condoms, many struggles to be convinced of its relative effectiveness and appeal.
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