Couples HIV Counseling and Testing

Category 3

The Rwanda Zambia Research Group (RZHRG) was formed in 1986 based on a study of HIV prevalence in pregnant women in Rwanda. Women participants in the study expressed a desire for partners to be tested and results showed that 14% of the women were in an HIV serodiscordant partnership, where one partner is HIV positive and the other is HIV negative. RZHRG developed a program where couples may be tested with their partners to learn their HIV status and where risk reduction interventions specifically for couples are implemented. RZHRG has the longest-standing and largest cohort of heterosexual discordant couples globally. RZHRG is known for the couples counseling and testing model implemented at its program sites.

Couple's counseling and testing is a service offered to all couples but also serves as the entry point for various research studies and clinical trials conducted by the program. Couples eligible for studies are invited to participate in follow-up research and provided with free outpatient reproductive health care and treatment of infectious diseases. All couples are able to return to the site for individual counseling as needed.

Goal of the Practice
  • The RZHRG helps couples to adequately protect themselves from HIV infection by providing couples the opportunity to learn of their HIV status.
  • The RZHRG helps couples to adequately protect themselves from HIV infection by providing risk reduction interventions tailored to each individual couple according to their HIV status
Core Components
  • The program sites provide: on-site couples voluntary HIV counseling and testing; STI screening and treatment; HIV treatment; reproductive health services
  • The Couples CT process includes a group discussion (10-25 couples) with a counselor followed by a confidential joint pre-test counseling session. Couples may choose to have their testing and post-test counseling done either as a couple or individually.
  • Each site staffs 5-10 full-time counselors with a capacity to provide services to 35 couples per day.
  • Influence Network Agents (INA) has been a successful intervention to promote couple's counseling and testing for RZHRG. INAs are community members that are recruited and trained to invite couples in their neighborhoods for couple's HIV counseling and testing.
Noteworthy Results
  • The couples counseling and testing intervention reduced HIV transmission within couples to 7-8% per year compared to 20-25% per year in serodiscordant couples who have not been counseled.
Lessons Learned
  • While the INA approach did increase couple's counseling and testing, the overall response rate was low in both Rwanda and Zambia where the intervention was studied. This may suggest that perhaps home-based HIV testing may help to increase couple's counseling and testing.
  • Using Influence Network Agents (INA) as a strategy helps to promote couple's counseling and testing and educate couples about HIV.
  • HIV positive men in serodiscordant couples reported less sexual activity but more likely to report 100% condom use, suggesting that men who know they are HIV positive are willing to use condoms to protect their uninfected spouse.
Focus Areas
Counseling and Testing
Implemented By
The Rwanda-Zambia Research Group
Participating Organization
  • Project San Francisco, Rwanda
  • Zambia-Emory HIV Research Project (ZEHRP), Zambia
  • Ubumi Bwesu-ZEHRP, Zambia
  • Rollins School of Public Health, Emory University
Target Population
Adults (over 18)
10000 - 25000
Implementation Years
01/2004 - ongoing