Voluntary confidential HIV testing for couples in Kigali, Rwanda

Abstract

It is estimated that 32% of adults in Kigali Rwanda are infected with HIV and the majority of incident infections occur in cohabiting couples. It has also been shown that voluntary HIV testing and counseling (CT) may be an effective tool for behavior change. Based upon the validity of this latter observation a volunteer CT program was conducted from October 1991 to January 1992 for cohabiting couples who presented together for pretest counseling and phlebotomy. Services were offered on weekends and advertised via radio in prenatal care clinics and among research study subjects. Participants were shown an informational/motivational video produced in the local language followed by a group discussion led by a trained health care worker. The demand for HIV testing is high in Kigali. Over the period 466 couples required testing. The number of couples increased steadily over time with 72% hearing about the service from people who had been tested previously. 74% were concordantly HIV-negative 15% were concordantly HIV-positive and 11% had discordant HIV results. Men were the HIV-positive partners in 54% of cases. In high-prevalence areas cohabiting couples make up a large proportion of those at risk for HIV infection yet many couples are unaware that only 1 partner may be infected despite several years of sexual contact. Counseling before and after testing offers an opportunity to discuss appropriate strategies for the couple. All individuals should be encouraged to use condoms with extramarital partners. Concordant-negative partners however do not need to use condoms within their relationship as long as both partners remain mutually faithful; discordant couples need to use condoms at all times; and concordant-positive couples need to consider effective long-term contraception.