HIV Status Awareness, Partnership Dissolution and HIV Transmission in Generalized Epidemics

Georges Reniers,Benjamin Armbruster,Carole Beaudoin

doi:10.1371/journal.pone.0050669

Abstract

ObjectivesHIV status aware couples with at least one HIV positive partner are characterized by high separation and divorce rates. This phenomenon is often described as a corollary of couples HIV Testing and Counseling (HTC) that ought to be minimized. In this contribution, we demonstrate the implications of partnership dissolution in serodiscordant couples for the propagation of HIV.MethodsWe develop a compartmental model to study epidemic outcomes of elevated partnership dissolution rates in serodiscordant couples and parameterize it with estimates from population-based data (Rakai, Uganda).ResultsVia its effect on partnership dissolution, every percentage point increase in HIV status awareness reduces HIV incidence in monogamous populations by 0.27 percent for women and 0.63 percent for men. These effects are even larger when the assumption of monogamy can be relaxed, but are moderated by other behavior changes (e.g., increased condom use) in HIV status aware serodiscordant partnerships. When these behavior changes are taken into account, each percentage point increase in HIV status awareness reduces HIV incidence by 0.13 and 0.32 percent for women and men, respectively (assuming monogamy). The partnership dissolution effect exists because it decreases the fraction of serodiscordant couples in the population and prolongs the time that individuals spend outside partnerships.ConclusionOur model predicts that elevated partnership dissolution rates in HIV status aware serodiscordant couples reduce the spread of HIV. As a consequence, the full impact of couples HTC for HIV prevention is probably larger than recognized to date. Particularly high partnership dissolution rates in female positive serodiscordant couples contribute to the gender imbalance in HIV infections.

Highlights

A handful of studies have documented relatively high separation and divorce rates in serodiscordant couples [1,2,3,4], but no study has evaluated its implications for the spread of HIV
Without any intent to minimize the possible hardship for the men and women in these situations, we argue that elevated partnership dissolution rates in HIV status aware serodiscordant couples have an unintended advantageous effect in the sense that they limit the spread of HIV
Our model suggests that elevated partnership dissolution rates in serodiscordant couples reduce HIV incidence

Summary

Introduction

A handful of studies have documented relatively high separation and divorce rates in serodiscordant couples [1,2,3,4], but no study has evaluated its implications for the spread of HIV. To the extent that partnership cessation has entered the debate on HIV prevention, it is usually considered a corollary of couples HIV Testing and Counseling (HTC) that ought to be minimized. In this contribution, we demonstrate by means of a mathematical model that partnership dissolution in serodiscordant couples can, under certain conditions, reduce the spread of HIV. That debate intensified following studies claiming that about half (or more) of all HIV affected cohabiting couples are serodiscordant [5,6]. The prominence of long-term serodiscordant partnerships for the spread of HIV is considered characteristic of mature generalized epidemics [8]. During the early stages of an epidemic, new infections are believed to stem more often from contacts with high-risk groups

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Conclusion