Relationship dynamics, intimate partner violence, and HIV prevention practices among serodiscordant couples in Mozambique – a qualitative study

Intimate partner violence (IPV) and HIV remain intersecting public health challenges in Mozambique, particularly among serodiscordant couples. This qualitative study explored how individuals in serodiscordant relationships described their intimate relationships following the discovery of HIV serodiscordance, and how these relationship dynamics were described in relation to engagement with HIV prevention practices. Eighteen serodiscordant couples (36 individuals) were recruited from health facilities in Gaza Province, Mozambique. Individual in-depth interviews were conducted between October and November 2022 and analysed using thematic analysis. Participants described emotional and relational responses following diagnosis, including betrayal, mistrust, uncertainty about relationship continuity. Ongoing dynamics included conflict, control, and experiences of IPV, as well as commitment, support, and communication. In some relationships, conflict, coercion, and violence limited participants' ability to negotiate condom use or avoid unprotected sex. In others, commitment and support facilitated condom use and engagement with treatment. Alcohol use was described in relation to both conflict and difficulties with safer sex. These findings highlight how HIV prevention within serodiscordant relationships is experienced in the context of relationship dynamics, including IPV. Interventions that address both relational dynamics and access to prevention may strengthen engagement with HIV prevention and care among serodiscordant couples.