Relational Choices and the Enactment of Therapeutic Citizenship among Sexual Minority Men on Antiretroviral Therapy in the SOAR Intervention, Eastern Cape, South Africa
1
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
2
David Geffen School of Medicine, University of California, Los Angeles, United States
3
Research Unit, Foundation for Professional Development, East London, South Africa
4
Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
5
Edson College of Nursing and Health Innovation, Arizona State University, Arizona, United States
Popul. Med. 2026;8(Supplement Supplement 1):A2712
ABSTRACT
BACKGROUND:
The scale-up of HIV care and prevention has reshaped sexual and illness identities among sexual minority men (SMM)¹'² who are disproportionately affected by HIV (22–48%) in South Africa³⁻⁵. HIV has shifted from a feared, mortal illness to a manageable condition, expanding relationship choices and reshaping health-oriented intimacy and responsibility⁶⁻⁹. Yet these relationship dynamics among SMM and the impact of SMM-centered skills-building interventions on these negotiations remain underexplored in this high-burden setting.
METHODS:
Twenty-one SMM from the Eastern Cape, South Africa (≥18 years, living with HIV, in a relationship < 3 months ago) participated in in-depth interviews during SOAR, a communication and coping skills intervention¹⁰'¹¹. Interviews covered partner and family communication including sexuality and HIV, treatment adherence, and intervention experiences. Audio recordings were translated from isiXhosa and analyzed iteratively using inductive coding, matrices, and team discussions. Therapeutic citizenship constructs guided interpretation, focusing on partner values, communication and resource access¹'¹²'¹³.
RESULTS:
Relationship type among SMM (median age 28 years (IQR 26–32); median HIV duration 3 years (IQR 1–7); 48% monogamous; 86% had viral loads <200) shaped the depth of health-related communication. Committed or serious partnerships enabled fuller enactments of therapeutic citizenship, characterized by trust, openness, and long-term treatment orientation. In contrast, casual relationships described as sex partners, “fuck buddies,” or “after nine”/closeted partners often complicated disclosure or HIV-related discussions, as participants weighed risks of stress against ethical engagement and future intimacy. Findings defined therapeutic citizenship as enactments of expected relational values, reciprocal partner support and disclosure timing, expanding relational meaning. Participation in SOAR strengthened therapeutic citizenship by enhancing agency, intimacy negotiation, and perceived responsibility.
CONCLUSIONS:
Relational choices and disclosure timing show how SMM balance intimacy and safety, with therapeutic citizenship unfolding over time through reciprocal disclosure and treatment management⁷'¹²'¹⁴. SMM-centered interventions can support coping, empowerment, and relationship negotiation.
The scale-up of HIV care and prevention has reshaped sexual and illness identities among sexual minority men (SMM)¹'² who are disproportionately affected by HIV (22–48%) in South Africa³⁻⁵. HIV has shifted from a feared, mortal illness to a manageable condition, expanding relationship choices and reshaping health-oriented intimacy and responsibility⁶⁻⁹. Yet these relationship dynamics among SMM and the impact of SMM-centered skills-building interventions on these negotiations remain underexplored in this high-burden setting.
METHODS:
Twenty-one SMM from the Eastern Cape, South Africa (≥18 years, living with HIV, in a relationship < 3 months ago) participated in in-depth interviews during SOAR, a communication and coping skills intervention¹⁰'¹¹. Interviews covered partner and family communication including sexuality and HIV, treatment adherence, and intervention experiences. Audio recordings were translated from isiXhosa and analyzed iteratively using inductive coding, matrices, and team discussions. Therapeutic citizenship constructs guided interpretation, focusing on partner values, communication and resource access¹'¹²'¹³.
RESULTS:
Relationship type among SMM (median age 28 years (IQR 26–32); median HIV duration 3 years (IQR 1–7); 48% monogamous; 86% had viral loads <200) shaped the depth of health-related communication. Committed or serious partnerships enabled fuller enactments of therapeutic citizenship, characterized by trust, openness, and long-term treatment orientation. In contrast, casual relationships described as sex partners, “fuck buddies,” or “after nine”/closeted partners often complicated disclosure or HIV-related discussions, as participants weighed risks of stress against ethical engagement and future intimacy. Findings defined therapeutic citizenship as enactments of expected relational values, reciprocal partner support and disclosure timing, expanding relational meaning. Participation in SOAR strengthened therapeutic citizenship by enhancing agency, intimacy negotiation, and perceived responsibility.
CONCLUSIONS:
Relational choices and disclosure timing show how SMM balance intimacy and safety, with therapeutic citizenship unfolding over time through reciprocal disclosure and treatment management⁷'¹²'¹⁴. SMM-centered interventions can support coping, empowerment, and relationship negotiation.
| eISSN: | 2654-1459 |
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