Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey

April L Kelley,Michel Carael,Steve M Dunham,Cheswa M Vwalika,Michele G Kautzman,Kristin M Wall,Susan A Allen,Elwyn Chomba,Joseph Telfair,Etienne Karita,Patrick S Sullivan,Francois Katangulia,Landon Myer

doi:10.1371/journal.pone.0019573

Abstract

BackgroundMost incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples' voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, <1% of couples have been jointly tested.MethodsWe conducted cross-sectional household surveys in Kigali, Rwanda (n = 600) and Lusaka, Zambia (n = 603) to ascertain knowledge, perceptions, and barriers to use of CVCT.ResultsCompared to Lusaka, Kigali respondents were significantly more aware of HIV testing sites (79% vs. 56%); had greater knowledge of HIV serodiscordance between couples (83% vs. 43%); believed CVCT is good (96% vs. 72%); and were willing to test jointly (91% vs. 47%). Stigma, fear of partner reaction, and distance/cost/logistics were CVCT barriers.ConclusionsThough most respondents had positive attitudes toward CVCT, the majority were unaware that serodiscordance between cohabiting couples is possible. Future messages should target gaps in knowledge about serodiscordance, provide logistical information about CVCT services, and aim to reduce stigma and fear.

Highlights

Sub-Saharan Africa remains the region of the world most heavily impacted by the HIV epidemic, accounting for 67% of all people living with HIV and 75% of AIDS deaths in 2007 [1]
It is estimated that half to three-quarters of new HIV infections could be prevented by voluntary HIV counseling and testing services targeted toward cohabiting couples [8]
Barriers to couples’ voluntary HIV counseling and testing (CVCT) include stigma, discrimination, gender inequality, concerns about confidentiality, lack of knowledge about availability of CVCT services, and misconceptions about HIV serodiscordance [6,10,11,12,13,14,15]

Summary

Introduction

Sub-Saharan Africa remains the region of the world most heavily impacted by the HIV epidemic, accounting for 67% of all people living with HIV and 75% of AIDS deaths in 2007 [1]. The majority of prevalent and incident infections in Africa are among cohabiting heterosexual couples [2,3,4]. It is estimated that half to three-quarters of new HIV infections could be prevented by voluntary HIV counseling and testing services targeted toward cohabiting couples [8]. Barriers to couples’ voluntary HIV counseling and testing (CVCT) include stigma, discrimination, gender inequality, concerns about confidentiality, lack of knowledge about availability of CVCT services, and misconceptions about HIV serodiscordance (i.e., partners may assume that the other partner shares their serostatus) [6,10,11,12,13,14,15]. Most incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples’ voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, ,1% of couples have been jointly tested

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