Psychiatric Comorbidities and Sexual Health Risk in HIV- Serodiscordant Heterosexual Couples Involving Women with Borderline Personality Disorder: A Qualitative Inquiry

Background: HIV-serodiscordant heterosexual couples are those where one partner is HIV-positive and the other is HIV-negative. Our previous studies found that the HIV-negative female partner in no-prevention couples (NPC) may be affected by borderline personality disorder (BPD) and may have a history of child abuse, trauma, and neglect. These couples offer valuable perspectives on public health, especially regarding the health behaviors and psychosocial factors that influence the relationship between psychopathology and illness behaviors related to borderline personality disorder and the transmission of sexually transmitted diseases. Population and Methods. The current study involves a three-phase project. In Phase One, we conducted a cross-sectional, multicenter anonymous survey of 175 HIV-serodiscordant couples regarding their preventive behaviors. We asked how often they used condoms during at-risk sexual encounters on a scale from 0% (‘never’) to 100% (‘always’). In Phase Two, which this current study mainly focuses on, we used qualitative, unstructured interviews and narrative analysis of HIV-negative female partners. The goal was to identify psychopathological comorbidities and health behaviors in women with BPD who are HIV-negative and stable partners of individuals with HIV who neglect primary prevention. In Phase Three, we analyzed the findings and developed a comprehensive healthcare model for women with BPD, as they appear to be the most vulnerable group for acquiring sexually transmitted HIV during stable relationships. Results. Specific health belief models and behaviors related to health emerged among HIV-negative female partners with borderline personality disorder (BPD) who decline prevention (DP) during behaviors that put them at risk for HIV sexual transmission in stable relationships with HIV-positive males. Women with BPD who have a history of child abuse and trauma often exhibit comorbid self-defeating personality disorder (SDPD), dependent personality disorder (DPD), and complex post-traumatic stress disorder (CPTSD). We could not replicate similar findings in HIV negative males. Conclusions. The current study confirms that health behaviors and women’s health are affected by underlying personality, behavioral, and psychosocial factors, which public health policymakers must address to improve the primary prevention of transmissible diseases. We suggest that child abuse, neglect, and trauma may be connected to overlooked health behaviors across a person's entire life span.