Abstract
BackgroundWe examined several measures of self-reported HIV risk behaviour in mutually disclosed sero-discordant couples over time to see if a couples counselling intervention was associated with changes in these behaviors.MethodsWe analysed data from a prospective cohort study of HIV sero-discordant couples in Jinja, Uganda collected between June 2009 and December 2011. Participants received couples counselling, at 3-monthly intervals. We examined trends in reported condom-use, number of concurrent sexual partners, knowledge of HIV serostatus of concurrent partners and condom use of concurrent partners using Generalized Estimating Equation models, comparing responses at study enrollment with responses at six, 12 18 and 24 months of follow-up.ResultsA total of 586 couples were enrolled and the female member was HIV positive in 255 (44%) of them. The median age for female participants was 35 years and 42 years for men. Reported condom use at last sex with spouse increased over time (p<0.001) with the largest increases found among couples where the positive participant never received ART during the study(an increase from 68.8% at enrollment to 97.1% at 24 months). Male participants reported reductions in the number of concurrent sexual partners (p<0.001), increase in the knowledge of the HIV serostatus of these partners (p = 0.001) and a trend towards improved condom-use among non-primary partners (p = 0.070). Reported reduced risky behaviors did not wane over the study period.ConclusionCouples counselling resulted in increased condom use among all participants and among men the intervention resulted in reductions in risk behaviour with concurrent sexual partners. Routine counselling for serodiscordant couples should be integrated in routine ART care programs.
Highlights
Reported condom use at last sex with spouse increased over time (p
Couples counselling resulted in increased condom use among all participants and among men the intervention resulted in reductions in risk behaviour with concurrent sexual partners
Serodiscordance among couples in sub-Saharan Africa is relatively common, occurring in 8–40% of couples who test for HIV representing the single largest group of preventable new infections. [4,5,6,7] Cheimatelly summarized DHS data regarding discordant relationships from 20 sub-Saharan African countries and has found that in high-prevalence countries, a large proportion of stable partnerships were affected by HIV and about half were discordant, whereas in low-prevalence countries, fewer stable partnerships were affected by HIV but a higher proportion of them were discordant
Summary
HIV serodiscordant couples in stable relationships are a major source of new infections in subSaharan Africa.[1,2,3,4,5] Serodiscordance among couples in sub-Saharan Africa is relatively common, occurring in 8–40% of couples who test for HIV representing the single largest group of preventable new infections. [4,5,6,7] Cheimatelly summarized DHS data regarding discordant relationships from 20 sub-Saharan African countries and has found that in high-prevalence countries (over 10% HIV prevalence), a large proportion of stable partnerships were affected by HIV and about half were discordant, whereas in low-prevalence countries (less than 10% HIV prevalence), fewer stable partnerships were affected by HIV but a higher proportion of them were discordant. [8] In Uganda, it is estimated that among those infected with HIV and living with a sexual partner, more than 50% of their partners are HIV uninfected and either acquired HIV before meeting their current partner or during a concurrent relationship. [9] While the provision of antiretroviral therapy (ART) has been demonstrated as a highly efficacious intervention to prevent HIV transmission within discordant couples[10], observational studies have shown that the incidence of HIV infection among negative partners of HIV positive individuals receiving ART can still be upwards of 3 per 100 person-years. [11] Among discordant couples who have not initiated ART, incidence can be as high as 25 per 100 person years.[12,13,14,15,16] even with the provision of HIV treatment, additional measures are needed for discordant couples to further reduce HIV transmission.As such, HIV serodiscordant couples, are recognized as a priority for HIV prevention in developing countries.[17]. [9] While the provision of antiretroviral therapy (ART) has been demonstrated as a highly efficacious intervention to prevent HIV transmission within discordant couples[10], observational studies have shown that the incidence of HIV infection among negative partners of HIV positive individuals receiving ART can still be upwards of 3 per 100 person-years. [18,19] For more than 20 years couples-based HIV counselling and testing (CHCT) is a proven strategy to reduce the risk of HIV transmission between sexual partners.[19,20,21] [22] one study reported that the initial impact of such counselling may wane over time. We examined several measures of self-reported HIV risk behaviour in mutually disclosed sero-discordant couples over time to see if a couples counselling intervention was associated with changes in these behaviors
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