Lived Experience of Intimate Partner Violence among Women with HIV/AIDS in Sero-discordant Couples in Rwanda: A Qualitative Phenomenological Study

In many parts of the world, the moment a person learns they have HIV can be a turning point, not just for their health, but for their entire life. For women living with the virus, this moment often happens within the context of a relationship. Sometimes, a woman discovers she is positive while her partner is negative; this situation is known as a sero-discordant relationship. While medical science has made incredible strides in treating HIV, allowing people to live long, healthy lives, the social and emotional landscape remains fraught with danger. Intimate partner violence, which includes physical hitting, sexual coercion, emotional humiliation, and the withholding of money or food, is a global crisis that disproportionately affects women. When a woman in a sero-discordant relationship discloses her status, the fear of rejection or anger from her partner can be overwhelming. This fear is not unfounded; the act of telling a partner about an HIV diagnosis can sometimes trigger abuse, creating a cycle where the need for safety prevents the woman from seeking the very care that keeps her healthy.

Researchers in Rwanda recently set out to understand this difficult reality by listening directly to the women living through it. They conducted a study to explore the lived experience of intimate partner violence among HIV-positive women who are in relationships with HIV-negative partners. Instead of relying on broad statistics or surveys, the researchers chose to sit down with fifteen women and listen to their stories in depth. These women, ranging in age from their early twenties to their sixties, were all receiving care and support from a network dedicated to people living with HIV in Kigali. The goal was not just to count how many women had been hurt, but to understand the texture of that hurt: how the relationship changed after the truth came out, how the women coped, and what they believed would help stop the violence.

The women who shared their stories described a landscape of relationships that shifted dramatically after the disclosure of HIV status. For some, a loving partnership dissolved into unhappiness and blame. One woman recounted how her husband began urging her toward divorce, making her feel that leaving was her only option. For others, the relationship was stable before the news but became strained afterward, with the emotional connection during intimacy fading away, though some couples eventually found a way to heal and move forward together. The moment of telling the partner was often the spark that ignited the conflict. Many women described their partners reacting with shock, disappointment, or depression, sometimes asking why they had not told them sooner. In a few cases, the partners were so distressed that they suggested ending the marriage immediately. However, the researchers also found that when both partners learned their status together, such as during prenatal care or pre-marital testing, the path was often smoother, with less blame and more joint decision-making.

The violence these women faced took many forms, often overlapping in a single relationship. Beyond the physical acts of hitting or pushing, the women spoke frequently about psychological and economic abuse. Some partners would publicly reveal the woman's HIV status to friends or family, stripping her of her privacy and dignity. Others would refuse to provide food or money for the household, even when the partner had a good income, leaving the woman in a state of poverty and insecurity. In some instances, the abuse turned sexual, with partners forcing intercourse despite the woman's lack of desire or refusal. The researchers noted that while physical violence was present, the emotional and financial control was often just as damaging, trapping women in abusive situations because they had no resources to leave.

Despite the severity of these experiences, the women showed remarkable resilience and offered clear ideas on how to break the cycle. Many found support in the people around them, turning to close friends, relatives, or peer educators—other women living with HIV who could offer empathy and practical advice. Health facility nurses also played a crucial role, providing a safe space for the women to speak and sometimes mediating with their partners. However, some women suffered in silence, feeling they had no one to trust. When asked what could be done to stop this violence, the women were direct. They called for stronger legal consequences for those who commit abuse, noting that the current laws were not always enforced. They also emphasized the need for more community education to change the mindset that blames women for the virus. Crucially, they suggested that healthcare providers should help facilitate the conversation about HIV status between partners, rather than leaving women to face the risk of disclosure alone. They also advocated for economic programs that would allow women to support themselves, reducing their dependence on abusive partners.

The study concludes that intimate partner violence is a significant, yet often overlooked, problem for HIV-positive women in sero-discordant relationships in Rwanda. The research suggests that the way a woman discloses her status is deeply tied to whether violence occurs. When disclosure happens without support, the risk of abuse rises. The findings point toward a need for a more integrated approach to care, where medical treatment for HIV is paired with protection from violence. By strengthening legal protections, ensuring that healthcare providers help couples navigate these difficult conversations, and providing women with economic independence, the cycle of violence can be interrupted. The women in this study did not just describe their suffering; they provided a roadmap for a safer future, urging that the community and the legal system step in to protect those who are already fighting to stay healthy.