#WomenofSU: Negotiating intimacy in a changing HIV landscape

Dr Lario Viljoen.

For her doctorate, sociobehavioural researcher Dr Lario Viljoen, associated with the Desmond Tutu TB Centre in the Department of Paediatrics and Child Health, explored how women negotiate sex, intimacy and health against the backdrop of new research showing that antiretroviral therapy can prevent the onward transmission of HIV in intimate relationships.

As part of commemorating South Africa's Women's Month, she tells us more about her research. 

Your doctoral research explored how women negotiate sex and intimacy in a changing HIV landscape. Tell us more about it.

The HIV epidemic has been devastating to South Africa, and women have been disproportionately affected by the disease. Recently, researchers found that antiretroviral therapy (ART) could be used to lower an infected person's viral count and, if the virus is sufficiently suppressed, prevent the onward transmission of the disease. Commonly referred to as 'treatment as prevention' (TasP), this method presents new opportunities for women in intimate relationships to make decisions around sex and HIV prevention. As part of my doctoral study in the Department of Sociology and Social Anthropology, I explored how women negotiate sex, intimacy and health in this changing context. The research, conducted with more than 80 households in the Western Cape over 18 months, was nested in an HIV prevention trial conducted by the Desmond Tutu TB Centre and other, international research partners. I focused on various issues that form part of women's experiences. At community level, I explored how TasP was understood by people living in the study areas, and how stigma forms changed when the HIV landscape shifted. I also studied the social processes involved when women disclosed their HIV status to their partners, how women made decisions around sex, and the extent to which TasP was part of the intimate narratives of people in settings with a high HIV burden.

My findings show that for communities to maximise the benefits of TasP, we need to explore how HIV prevention modalities, appropriate stigma reduction programmes, TasP awareness campaigns and couples counselling can best be incorporated into national health programmes.

Why or how did you become interested in this specific area of research?

My academic interest in gender stems from my undergraduate years studying in Stellenbosch University's Department of Sociology. I joined the Desmond Tutu TB Centre in 2012 as part of a social-science team working on a multi-country HIV prevention trial. Working in communities affected by HIV, I saw how women managed relationships, intimacy and love. The complexity of intimate relationships is largely overlooked in biomedical studies, and it was clear that exploring women's experiences in this regard was both necessary and important in the fight against HIV. 

Why do you think this is such an important research area for women in South Africa?

Women continue to bear the brunt of HIV in South Africa. As HIV treatment and prevention modalities continue to evolve, it is important that we do everything in our power to understand how women can best benefit from these new technologies in ways that suit their lives and their intimate relationships. This includes exploring new ways to allow women to have both healthy bodies and healthy relationships.

The COVID-19 pandemic has changed the way we work and live. What keeps you motivated during these times?

I have been fortunate to be working mostly from home this past year and a half. Although it has been challenging to balance studies, work and family, I believe that writing down and keeping track of both short and long-term goals is essential to keep motivated. In addition, giving yourself some grace in these extraordinary circumstances is not only allowed, but crucial.

What would your message be to the next generation of women researchers?

We are in the fortunate position where many strong women have paved the way for future female researchers. We have the opportunity and responsibility to make a difference in academia. Do not be afraid to tackle the difficult questions – your voice, your expertise and your point of view matter.

Daniel Bugan