Abstract

Background HIV-serodiscordant heterosexual couples, where one partner is HIV-positive and the other HIV-negative, provide important insights into public health when prevention is declined. Prior studies suggested that HIV-negative female partners may present borderline personality disorder (BPD), often linked to child abuse, trauma, and neglect. Methods This study surveyed 175 couples to assess condom use, followed by qualitative interviews with HIV-negative female partners. Narrative analysis consistently revealed BPD and associated psychopathology, leading to the development of a theoretical model integrating quantitative and qualitative findings to explain how BPD-related psychopathology interacts with relational dynamics and HIV risk behaviors. Results HIV-negative women with BPD who declined prevention frequently exhibited comorbid self-defeating personality disorder (SDPD), dependent personality disorder (DPD), and complex PTSD, adopting health belief models and behaviors that heightened vulnerability to HIV transmission. Comparable findings were not observed in HIV-negative males. Conclusions Women’s health behaviors are shaped by personality, trauma, and psychosocial factors, which may act as hidden drivers of pandemic transmission. Public health strategies must integrate trauma-informed and personality-focused interventions, recognizing the lifelong impact of abuse and neglect to strengthen prevention and reduce the spread of HIV and other sexually transmitted diseases.