HIV Prevention for Serodiscordant Couples
What We Know
AIDSTAR-One Technical Brief on HIV Prevention for Serodiscordant Couples (pending, 2009 release)
Summaries of Select Background Research on HIV Serodiscordant Couples
The following select articles highlight research findings on serodiscordant partnerships. Brief summaries of the articles are directly taken or summarized from the article abstracts (complete abstracts can be found on PubMed or Medline).
HIV Transmission Risk Behavior among HIV-infected Adults in Uganda: Results of a Nationally Representative Survey
AIDS (2008), Vol. 22 No. 5, pp. 617-624
Bunnel, R., et al.
This national cross-sectional study examined factors associated with HIV transmission risk among HIV-infected Ugandan adults. The majority of persons were not aware of their HIV status (79 percent), and few reported condom use at last sex encounter. Yet nearly half (40 percent) of the cohabitating persons had an HIV-negative spouse. Individuals who knew their HIV status (21%) were three times more likely to use a condom at last sex act compared to those who were not tested for HIV. Those who knew their partners’ HIV status (9percent) were 2.3 times more likely to use condoms at last sex act than those who did not know their partners’ HIV status. Despite this finding, among this national sample of HIV-infected Ugandan adults, 91 percent did not know their partner’s status. Findings highlight the need for interventions to support HIV testing among partners.
Living with Discordance: Knowledge, Challenges, and Prevention Strategies of HIV-discordant Couples in Uganda
AIDS Care (2005), Vol. 17 No. 8, pp. 999-1012
Bunnell, R., et al.
This qualitative study explored understanding of discordance among HIV discordant couples who sought voluntary counseling and testing in Uganda. The study found that misconceptions about discordance were widespread. Common explanations included: the concept of a hidden infection not detectable by HIV tests (i.e., that the HIV negative partner is actually infected), belief in immunity, the thought that gentle sex protected HIV negative partners, and belief in protection by God. The study also found that the majority of counselors lacked clear explanations for HIV discordance.
New Heterosexually Transmitted HIV Infections in Married or Cohabiting Couples in Urban Zambia and Rwanda: An Analysis of Survey and Clinical Data
The Lancet (2008), Vol. 371 No. 9631, pp. 2183-2191
Dunkle, K., et al.
Most HIV transmission in sub-Saharan Africa is due to heterosexual transmission. The degree to which HIV transmission occurs within relationships is a critical question. Using data from Demographic and Health Surveys (DHS) in Zambia and Rwanda, and data from couples (married, cohabiting, and non-cohabiting) from a voluntary counseling and testing service, the study estimates that 55.1 percent to 92.7percent of new heterosexually acquired HIV infections among adults occurred within serodiscordant marital or cohabiting relationships. Applying a statistical model that took into account the higher rates of reported condom use in non-cohabiting partners, researchers estimated that from 60.3 percent to 94.2 percent of new heterosexually acquired infections occurred within marriage or cohabitation.
HIV-1-discordant Couples in sub-Saharan Africa: Explanations and Implications for High Rates of Discordancy
Current HIV Research (2007), Vol. 5 No. 4, pp. 416-429
Guthrie, B., de Bruyn, G. & Farquhar, C.
A review of published studies on discordant couples was undertaken to ascertain factors that may explain high rates of HIV discordance and why some individuals remain uninfected despite repeated exposure to HIV. The review identified a number of correlates of transmission including: sexually transmitted infections (STIs), particularly genital ulcerative diseases; HIV viral load; condom use; and specific sexual practices, particularly high number of sexual partners and higher frequency of sexual contact. The authors highlight the importance of timing of HIV infection relative to relationship formation when examining the progression of the epidemic at the population level. One hypothesis they put forward is that in early epidemics, most discordant couples arise when HIV is introduced into a preexisting relationship; in more mature epidemics, where there are many more people who have been infected with HIV, a greater proportion of discordant couples initiate relationships with a partner already infected. The authors recommend targeted interventions to identify acute infections, diagnose and treat STIs and promote condom use in non-monogamous couples.
Sero-discordant Couples in Five African Countries: Implications for Prevention Strategies
Population and Development Review (2007), Vol. 33 No. 3, pp. 501-523
de Walque, D.
This paper examines nationally representative samples, which include the results of HIV tests, to identify two surprising findings in relation to serodiscordant couples. First, at least two-thirds of infected couples were discordant couples. This finding highlights the importance of directing prevention efforts toward serodiscordant couples. Second, in 30-40 percent of infected couples, only the female partner is infected. The latter finding highlights the need to target prevention efforts toward both women and men engaging in sexual activity outside of a primary relationship.
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