HIV Serodiscordant Research Articles

Condom Failure Among HIV-Negative Men in Serodiscordant Relationships in Australia, Brazil, and Thailand

Condoms continue to be used by many gay, bisexual, and other men who have sex with men (GBM) to reduce the risk of HIV transmission. However this is impacted by condom failure events, defined here as condom breakage and slippage. In a prospective, observational cohort study of 343 HIV serodiscordant male couples recruited through high HIV caseload clinics and hospitals between 2012 and 2016 in Australia, Brazil, and Thailand, condom failure rates and associated factors were analysed, including with the study partner versus other sexual partners. There were 717 reported instances of condom failure from an estimated total of 25,831 sex acts with condoms, from over 588.4 participant years of follow up. Of the HIV-negative partners (n = 343) in the study, more than a third (n = 117, 36.7%) reported at least one instance of condom failure with any partner type during study follow-up. Condom failure with their study partner was reported by 91/343 (26.5%) HIV-negative partners, compared with 43/343 (12.5%) who reported condom failure with other partners. In total, there were 86 events where the HIV-negative partner experienced ano-receptive condom failure with ejaculation, representing 12.0% of all failure events. In multivariable analysis, compared to Australia, HIV-negative men in Brazil reported a higher incidence risk rate of condom failure (IRR = 1.64, 95%CI 1.01–2.68, p = 0.046) and HIV-negative men who reported anal sex with other partners reported an increased risk of condom failure compared with men who only had sex with their study partner (IRR = 1.89, 95%CI 1.08–3.33, p = 0.025). Although at least one event of condom failure was reported by a significant proportion of participants, overall condom failure events represented a small proportion of the total condom protected sex acts.

Level of HIV serodiscordance and associated factors among heterosexual couples in Ethiopia: A systematic review and meta-analysis.

HIV-related causes accounted for approximately 770,000 deaths globally in 2018. Globally, there were 1.7 million new infections, and approximately 37.9 million people were living with HIV by the end of 2018. According to the WHO 2018 study, the African Region was the most affected, with 25.7 million people living with HIV in 2018. In Africa, married and cohabiting couples have a high prevalence of HIV discordance, ranging from 3% to 20% in the general population. Therefore, it is crucial to understand the level of HIV serodiscordance among married couples in Ethiopia and the contributing factors. Studies were systematically searched, utilizing international databases such as PubMed, Google Scholar, Cochrane Library, and Embase. The level of quality of the included articles, which employed cross-sectional and cohort study designs, was evaluated using the New Castle Ottawa scale. The systematic review employed a random-effects approach, and statistical analysis was conducted using STATA version 17 software. The presence of statistical heterogeneity within the included studies was assessed using the I-squared statistic. The random-effects meta-analysis model was used to estimate the pooled level of HIV serodiscordance. The results were reported following the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guideline. A total of ten (10) observational studies were included in this review. The pooled level of HIV serodiscordance among married heterosexual couples in Ethiopia was found to be 11.4% (95% CI = 7% -15.7%). The results from the meta-analysis indicated a significant positive association between HIV serodiscordance and the variables studied. Specifically, consistently using condoms (OR = 1.82; 95% CI: 1.08-2.56), having a CD4 count of >200 cells/mm3 (OR = 1.45; 95% CI: 1.12-1.77), and having a premarital sexual relationship (OR = 1.93; 95% CI: 1.28-2.57) were strongly linked to couples' serodiscordance. To protect a seronegative partner in a serodiscordant relationship from acquiring HIV infection, it is crucial to implement preventive measures. These measures include providing comprehensive health education on the correct and consistent use of condoms, ensuring regular monitoring and care at an antiretroviral therapy (ART) clinic, and offering voluntary counseling and testing (VCT) services to both sexual partners.

Reproductive health needs of HIV serodiscordant couples: a systematic review.

HIV is closely linked to reproductive and sexual health. HIV Serodiscordant couples face significant social, reproductive, and sexual challenges. This systematic review aimed to identify their reproductive health needs. A comprehensive literature search was conducted across six databases: Scopus, PubMed, Web of Science, Google Scholar, Magiran, and Iranmedex. No date restrictions were applied, and only English-language articles published before February 21, 2023, were included. We also searched the grey literature and conducted forward/backward citation searches. From an initial 758 articles, 18 met the inclusion criteria. Studies were qualitative (n = 10) and quantitative (n = 8). Key reproductive health needs included (1) childbearing intention, (2) HIV serodiscordance and sexuality, (3) psychological and social support, (4) training and consultation services, (5) access to reliable information, and (6) focused training for healthcare providers. HIV-discordant couples face various reproductive health challenges. Implementing comprehensive guidelines for reproductive and sexual health, rehabilitation, and fertility planning is crucial to improving their quality of life and health. https://www.crd.york.ac.uk/prospero/, identifier CRD42023393567.

Subclinical cardiovascular remodelling in HIV-infection: A multimodal case study of 2 serodiscordant, monozygotic twins.

Cardiovascular abnormalities are increasingly recognised among people newly diagnosed with HIV, but subclinical pathology may be challenging to diagnose. We present a case study of subtle cardiovascular changes in identical twins, one without HIV-infection and the other recently diagnosed with HIV (serodiscordant). We hypothesise that cardiovascular parameters would be similar between the twins, unless non-genetic (environmental) factors are at play. These differences likely represent occult pathology secondary to the effects of early HIV-infection. A 25-year-old female incidentally diagnosed with HIV, and her HIV-uninfected identical twin, living with her since birth, underwent comprehensive cardiovascular assessments. The HIV-positive twin exhibited a globular left ventricle (LV), larger LV volumes, decreased LV strain, peak atrial longitudinal strain (PALS) and higher native T1 and T2 mapping values compared to her sister. Cardiac biomarkers high sensitivity cardiac troponin T and N-terminal proBNP, as well as the novel markers of fibrosis and remodelling, galectin-3 and soluble-ST2, were higher in the HIV-infected twin. Given the twins' shared environment and genetic makeup, these differences likely stem from HIV-infection. Our study supports previous findings and suggests potential screening markers for HIV-associated cardiovascular disease, including PALS. Further research is warranted to explore PALS' utility in this context.

Common Dyadic Coping Mediates the Associations Between We-Disease Appraisal and Relationship Satisfaction and Quality of Life in HIV Serodiscordant Couples: The Common Fate Mediation Model.

Since HIV has evolved into a lifelong but manageable condition, improving the quality of life (QoL) of persons living with HIV (PLWHs) has become increasingly important. Living with HIV is life-altering and poses substantial challenges for both PLWHs and their partners, so identifying how HIV serodiscordant couples cope with HIV together is crucial. Here, Bodenmann's Systemic Transaction Model highlights common dyadic coping (CDC), which refers to both partners working together to alleviate the negative effects of stress. We examined the mediating role of CDC in linking we-disease appraisal with relationship satisfaction and QoL. We recruited a convenience sample of 231 HIV serodiscordant couples via local grassroots organizations between June and October 2022. Participants completed measures of we-disease appraisal, CDC, relationship satisfaction, and QoL. We examined the mediation effect of CDC on the association between we-disease appraisal and outcomes using the common fate mediation model. The mean age of PLWHs was 32.18 years (standard deviation = 8.61 years), and that of their partners was 32.55 years (standard deviation = 9.24 years). The average time since HIV diagnosis was 4.18 years. Most couples were same-sex male couples. We found that CDC mediated the effect of we-disease appraisal on relationship satisfaction. Moreover, CDC significantly mediated the effect of we-disease appraisal on the QoL of PLWHs and their partners. Our findings highlight the importance of CDC in dyadic illness management among Chinese HIV serodiscordant couples.

Measuring structural HIV stigma

Despite the progress in pharmaceutical and epidemiological tools for combating HIV spread, HIV stigma remains a significant social barrier impeding treatment and prevention efforts, potentially reducing the effectiveness of interventions to reduce HIV transmission. In this paper, we propose a novel approach to defining and estimating HIV stigmatization through the structure of sexual relations, as opposed to attitudes. We conceptualize structural stigma as arising from two mechanisms: (1) a reduced propensity towards HIV serodiscordant partnerships (exclusion); and (2) a reduced propensity towards partnerships with seroconcordant individuals who themselves have serodiscordant partnerships (ostracism). Both mechanisms can be assessed from observed partnership network data using exponential family random graph models (ERGMs). We demonstrate our approach on a sexual contact network of black men who have sex with men in the South Side of Chicago. We find a tendency for serodiscordant sexual relationships to be suppressed in the network (θ = −0.69, p < .05), as well as a suppressive tendency for HIV negative YBMSM to have sex with other HIV negative people in serodiscordant relationships (θ = −0.96, p < .05) suggesting that structural HIV stigma is present in this network. Potential relationships with attitudinal stigma and implications for epidemiological strategies for reducing HIV stigma are discussed.

Occurrence and Factors Associated with HIV-Sero-Discordance in Couples at Iganga General Hospital-Iganga District, Eastern Uganda

HIV sero-discordant refers to a situation where in a pair of long-term sexual partners, one is HIV positive and the other is HIV negative. There is an increased risk of HIV transmission to the HIV-negative partner in discordant couples which makes HIV serodiscordant a hindrance to HIV control and prevention strategies. Sero-discordance is one of the factors affecting the impact of HIV prevention strategies, therefore effective HIV prevention strategies must consider HIV discordance. Limited knowledge about the prevalence of HIV serodiscordant in the community hinders the formulation of appropriate strategies for effective control of HIV transmission. The study was aimed at determining the prevalence of HIV serodiscordant and its associated factors among couples attending Iganga General Hospital. The knowledge generated will guide the stakeholders in formulating HIV prevention and control strategies aimed at reducing HIV transmission. A cross-sectional hospital-based study was carried out through the conduction of guided interviews using a questionnaire to random-systematically selected 250 couples attending IGH. Data was analyzed and presented in tables with percentages comparing different factors. The HIV seroprevalence was 6.8%. The prevalence of discordance was 4.8% among participant couples and 52.2% among the infected couples. HIV serodiscordant was associated with sexual practice (83.3%), circumcision status of the male partner in the couple (58.3%), condom use (58.3%), use of ARVs by the HIV-infected partner (25%), and experience of STIs among partners (25%). The prevalence of HIV serodiscordant among the participant couples was 4.8%, associated mainly with sexual practice, circumcision, and condom use. Keywords: HIV transmission, Discordant couples, Sexual partners, Condom, Serodiscordant

Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64–6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48–7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.

Provider perspectives on service delivery modifications to maintain access to HIV pre‐exposure prophylaxis during the COVID‐19 pandemic: qualitative results from a PrEP implementation project in Kenya

HIV pre-exposure prophylaxis (PrEP) is an essential prevention strategy being scaled up for priority populations in Kenya, including for HIV serodiscordant couples. The COVID-19 pandemic posed challenges to PrEP rollout. We conducted a qualitative study of PrEP providers to understand how clinics adjusted PrEP delivery during the COVID-19 pandemic. Since 2017, the Partners Scale-Up Project has integrated PrEP into 25 HIV clinics in Central and Western Kenya. We conducted qualitative interviews with 40 purposively sampled clinic personnel. We interviewed personnel once during the first pandemic wave (May-Aug 2020) and again after some decline in COVID-19 rates (Nov-Jan 2021). We analysed data using inductive memo-writing and summarized data by themes along the PrEP delivery cascade, guided by the Framework for Reporting Adaptation and Modifications (FRAME). We interviewed 27 clinical officers, five nurses, four health records and information officers, and four counsellors from Central (n=20) and Western (n=20) Kenya. About half (n=19) were female, with a median age of 32 (IQR: 29-34) and 2.3 years of experience delivering PrEP (IQR: 2-3). All participants reported clinic changes in PrEP demand creation and service delivery during the pandemic. Modifications occurred during PrEP implementation and sustainment phases, were partly reactive to the pandemic and also facilitated by interim Ministry of Health guidance on PrEP delivery during COVID, and were made by PrEP delivery teams, clients and clinic managers. Commonly reported modifications included dispensing multiple-month PrEP refills, intensifying phone-based client engagement and collaborating with other HIV clinics to ensure that clients with prolonged stays in other regions could continue to access PrEP. Some clinics also adopted practices to streamline visits, such as within clinical-room PrEP dispensing, pre-packing PrEP and task-shifting. Most providers liked these changes and hoped they would continue after the pandemic subsides. COVID-19 served as a catalyst for PrEP delivery innovations in Kenya. HIV clinics successfully and rapidly adapted their PrEP demand creation, refill and retention strategies to promote PrEP uptake and effective use. These modified implementation strategies highlight opportunities to streamline the delivery of PrEP, as well as other HIV and chronic care services, and strengthen engagement with populations post-pandemic.

Prevalence and Factors Associated with HIV Serodiscordance among Infected Couples in the City of Parakou (Benin)

Prevalence and Factors Associated with HIV Serodiscordance among Infected Couples in the City of Parakou (Benin)

Modeling the Probability of HIV Infection over Time in High-Risk Seronegative Participants Receiving Placebo in Five Randomized Double-Blind Placebo-Controlled HIV Pre-Exposure Prophylaxis Trials: A Patient-Level Pooled Analysis.

The World Health Organization recommends pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV infection. The aim of this analysis is to quantify the individual risk of HIV infection over time, using a large database of high-risk individuals (n = 5583). We used data from placebo recipients in five phase III PrEP trials: iPrEx, conducted in men who have sex with men and transgender women; VOICE, conducted in young women at high sexual risk; Partners PrEP, conducted in HIV serodiscordant heterosexual couples; TDF2, conducted in high-risk heterosexual men and women; and BTS, conducted in persons who inject drugs. The probability of HIV infection over time was estimated using NONMEM7.4. We identified predictors of HIV risk and found a substantial difference in the risk of infection among and within trial populations, with each study including a mix of low, moderate, and high-risk individuals (p < 0.05). Persons who were female at birth were at a higher risk of HIV infection than people who were male at birth. Final models were integrated in a tool that can assess person-specific risk and simulate cumulative HIV risk over time. These models can be used to optimize future PrEP clinical trials by identifying potential participants at highest risk.

Pattern of Lipid Profile Levels in HIV Serodiscordant Couples in Jos Plataeu State, Nigeria

This was a cross sectional study designed to determine the pattern of lipid profile levels in HIV serodiscordant couples in Jos, Nigeria. A total of 20 discordant HIV couples (40 patients) and 20 controls (40 non HIV couples) aged between 18 and 49 years were included in the study. 5ml of fasting venous blood sample was collected from each participant into plain containers for the evaluation of lipid profile. Total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), very low density lipoprotein cholesterol (VLDL-C) and low density lipoprotein cholesterol (LDL-C) were assayed using standard methods. The results showed that HIV discordant test group had significantly higher mean serum TG, VLDL-C, and LDL-C levels whereas HDL-C values were significantly lower than in the control (p&lt;0.05). There was no significant difference in TC levels in groups when compared to the control (p&gt;0.05). The male HIV discordant test group had higher TG and VLDL-C values (p=0.001; 0.002) and lower HDL-C (p=0.000) than in the male control group (p=0.001) while the female HIV discordant test group had significantly higher LDL-C and lower HDL-C levels (p=0.001; 0.000) than in female control group. Male HIV-exposed seronegative partners had significantly higher TG and VLDL-C with lower HDL-C levels (p&lt;0.05) compared to male control while female exposed seronegatives had significantly lower HDL-C level (p=0.000) than in the female control. Furthermore, female HIV positives had significantly higher LDL-C and lower HDL-C levels than in the female control (p&lt;0.05). This study revealed significant alterations in lipid profile levels in the HIV serodiscordant couples which warrant further studies.

Psychosocial support for HIV serodiscordant couples

ABSTRACT Introduction South Africa has the largest HIV epidemic, with 8.2 million people living with the virus. It has a high HIV prevalence of 13.7% and 230,000 new infections in 2020. It is estimated that HIV serodiscordant couples contribute up to 60% of new HIV infections in sub-Saharan Africa. However, there have been no specific programmes/activities to deliberately cater for couples in HIV serodiscordant relationships. The purpose of this study was to examine the psychosocial support provided for HIV serodiscordant couples both in health care settings and in the community. Methods An interpretative phenomenological analysis (IPA) design was utilised for this study. In-depth interviews were conducted with thirteen HIV serodiscordant couples. Data collection was guided by an interview guide. All audio-recorded interview data were transcribed verbatim into written text. Data analysis was conducted using an interpretative phenomenological analysis framework. A third person-an expert in qualitative research, acted as an independent co-coder and conducted the open coding of each transcript. Findings The findings indicated that HIV serodiscordant couples received psychosocial support from their partners, family, and health care workers. This support was emotional, or in the form of counselling, reminders on taking medication, financial and household chores. The support provided by health care providers proved to be deficient and did not address the diverse needs of this group. Conclusion Psychosocial support plays a critical role in enhancing the quality of life of HIV serodiscordant couples. Therefore, client centred, and tailor-made interventions should be made available to this special with diverse needs group.

KIR2DL5B and HLA DRB1*12 alleles seems to be associated with protection against HIV-1 in serodiscordant couples in Burkina Faso.

The human immunodeficiency virus (HIV) belongs to the Retroviridae family and remains a public health problem in sub-Saharan Africa. Recent reports from WHO have shown that 33 million people died from HIV infections. HIV is one of the most serious fatal human diseases of the 20thand 21stcenturies. However, variations in genetic and immunological factors are associated with protection against HIV infection in uninfected people exposed to HIV. This is the case with naturals killers which play an important role in the progression or regression of HIV infection. The objective of this study is to characterize certain HLA (human leukocyte antigen) class II genes and KIR genes in HIV-1 serodiscordant couples in Burkina Faso. This study was carried out at Burkina Faso among nineteen (19) HIV-1 serodiscordant couples. Classical multiplex PCR (SSP-PCR) was used to characterize the presence or absence of the KIR genes and certain class II HLAs (DRB1*11 and DRB1*12). The characterization of the KIR and HLA genes DRB1*11, DRB1*12 in this study demonstrated that the inhibitor KIR2DL5B, would confer protection against HIV-1 infection in seronegative partners (odd ratio [OR] = 0.13 [0.02-0.72]and p = 0.029), and the HLA DRB1*12 allele was associated with protection against HIV-1 infection in seronegative partners (OR = 0.16 [0.03-0.77]and p = 0.038). AA and Bx haplotypes were not found to be associated with HIV-1 infection in serodiscordant couples. This study confirms the involvement of the KIR genes in viral pathologies such as HIV-1 infection. Future larger-scale studies may provide a better understanding of the molecular mechanism by which the KIR haplotype and combination of KIR/HLA are associated with protection against HIV infection.

Effectiveness of three delivery models for promoting access to pre-exposure prophylaxis in HIV-1 serodiscordant couples in Nigeria.

To evaluate the effectiveness of three models for pre-exposure prophylaxis (PrEP) service delivery to HIV-1 serodiscordant couples in Nigeria. 297 heterosexual HIV-1 serodiscordant couples were recruited into three PrEP delivery models and followed up for 18 months. The models were i) Outpatient clinic model providing PreP in routine outpatient care; ii) Antiretroviral therapy (ART) clinic model providing PrEP in ART clinics; and iii) Decentralized care model providing PrEP through primary and secondary care centres linked to a tertiary care centre. The primary effectiveness endpoint was incident HIV-1 infection. The HIV incidence before and after the study was compared and the incidence rate ratio computed for each model. Survival analysis was conducted, Cox regression analysis was used to compare the factors that influenced couple retention in each of the models. Kaplan-Meier survival analysis was used to estimate the median retention time (in months) of the study participants in each of the study models, and log-rank test for equality of survival functions was conducted to test for significant differences among the three models. There was no significant difference (p>0.05) in the couple retention rates among the three models. At months 3, 6 and 9, adherence of the HIV-1-infected partners to ART was highest in the decentralized model, whereas at months 9 and 12, the outpatient model had the highest proportion of HIV-1- uninfected partners adhering to PrEP (p<0.001). The HIV incidence per 100 person-years was zero in the general outpatient clinic and ART clinic models and 1.6 (95% CI: 0.04-9.1) in the decentralized clinic model. The difference in the observed and expected incidence rate was 4.3 (95% CI: 0.44-39.57) for the decentralized clinic model. Although incidence of HIV seroconversion was highest in the decentralized clinic model, this difference may be due to the higher sexual risk behavior among study participants in the decentralized model rather than the type of service delivery. The study findings imply that any of the models can effectively deliver PrEP services.

HIV pre-exposure prophylaxis: assessment of acceptability among members of HIV serodiscordant/serostatus unknown couples.

Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection but is not yet widely available in resource-limited settings such as the Dominican Republic. We aimed to ascertain PrEP acceptability among people living with HIV in the Dominican Republic who are part of HIV serodiscordant partnerships and understand relationships between PrEP acceptability, HIV stigma, and intimate partner violence.Methods: A cross-sectional survey of people in care for HIV infection included acceptability-related questions and assessments of HIV stigma and intimate partner violence. We also explored the expected impact of PrEP on HIV disclosure rates and fertility intentions.Results: Of the 100 participants, 74% had been in their current partnership for >1year; 38% had not disclosed to their partner; 29% reported condomless sex, and 23% reported sex with multiple partners. PrEP was highly acceptable with 84% of participants saying they were "very likely" to offer PrEP to their partner if available and 21% stating it would allow them to have more children. Of those who had not disclosed to their partner, 71% stated PrEP would help them do so. No relationship was found between PrEP acceptability, HIV stigma, and intimate partner violence. However, higher than expected rates of PrEP acceptability limited the power of these analyses.Conclusion: Pre-exposure prophylaxis was considered to be highly acceptable among people living with HIV in the Dominican Republic who are part of serodiscordant partnerships.

Alloimmunity to Class 2 Human Leucocyte Antigens May Reduce HIV-1 Acquisition - A Nested Case-Control Study in HIV-1 Serodiscordant Couples.

Enveloped viruses, including the Human Immunodeficiency Virus-1 (HIV), incorporate host proteins such as human leucocyte antigens (HLA) into their envelope. Pre-existing antibodies against HLA, termed HLA antibodies, may bind to these surface proteins and reduce viral infectivity. Related evidence includes macaque studies which suggest that xenoimmunization with HLA antigens may protect against simian immunodeficiency virus infection. Since HIV gp120 shows homology with class 2 HLA, including shared affinity for binding to CD4, class 2 HLA antibodies may influence HIV acquisition via binding to gp120 on the viral envelope. We conducted a nested case-control study on HIV serodiscordant couples, comparing the frequency of HLA antibodies among highly exposed persistently seronegative controls with those who went on to acquire HIV (HIV-seroconverters). We first performed low resolution HLA typing on 143 individuals who were HIV-infected at enrollment (index partners) and their corresponding sexual partners (115 highly exposed persistently seronegative individuals and 28 HIV-seroconverters). We then measured HLA class 1 and 2 antibodies in the highly exposed persistently seronegative individuals and HIV-seroconverters at early and late timepoints. We analyzed whether such antibodies were directed at HLA specificities of their HIV-infected index partners, and whether autoantibodies or complement-fixing class 2 HLA antibodies were present. Seventy-nine percent of highly exposed persistently seronegative individuals had HLA antibodies; 56% against class 1 and 50% against class 2 alleles. Half of the group of highly exposed persistently seronegative individuals, prior to seroconversion, expressed class 2 HLA antibodies, compared with only 29% of controls (p=0.05). HIV infection was a sensitizing event leading to de novo development of antibodies against HLA-A and HLA-B loci, but not against class 2 loci. HLA autoantibodies were present in 27% of highly exposed persistently seronegative individuals. Complement-fixing class 2 HLA antibodies did not differ significantly between highly exposed persistently seronegative individuals and seroconverters. In multivariable regression, presence of class 2 HLA antibodies at early timepoints was associated with reduced odds of HIV acquisition (odds ratio 0.330, confidence interval 0.112-0.976, p=0.045). These epidemiological data suggest that pre-existing class 2 HLA antibodies were associated with reduced odds of HIV acquisition.

Condom use consistency among South African HIV serodiscordant couples following an HIV risk-reduction intervention.

Background: Although there are several ways to transmit HIV, condomless sex remains the primary mode in sub-Saharan Africa, including South Africa, with KwaZulu-Natal Province being one of the epicentres of HIV infection. This study explored the use of condoms in serodiscordant couples who were exposed to an HIV-risk reduction intervention that aimed to improve condom use and reduce the spread of HIV.Methods: A Total of 30 couples completed a paper-based questionnaire on their demographics and general health at baseline and 3months, plus a semi-structured questionnaire with four domains. An analysis of HIV knowledge, condom use, condom use attitudes and protection perceptions about how other serodiscordant couples behave was conducted following a 12-week HIV risk reduction intervention. Participants were randomised 2:1 into intervention and control groups.Results: Condom use increased from 55% at baseline to 73.7% (p = .0047) at 3months for the intervention group and condom use in the last 7 days increased from 53% to 86% (p = .0117). For the control group, condom use remained low at the 3months follow up period (p = .625). HIV knowledge improved significantly from baseline to 3months for the intervention group (p < .0001), as well as the control group (p = .0005). Negative HIV condom use attitude scores in both groups decreased significantly from baseline to 3months; intervention group (p = .0059) and control group (p = .0007).Conclusion: HIV knowledge and condom use improved significantly, while negative condom use attitudes and HIV protection perceptions decreased significantly following exposure to a risk-reduction intervention, suggesting that HIV preventive interventions should focus on partnership interventions.

Reproductive planning and pregnancy of HIV serodiscordant couples: a phenomenological study.

To understand the experience of reproductive planning and pregnancy for HIV serodiscordant couples. Qualitative study, with phenomenological approach, theoretical-philosophical-methodological framework of Martin Heidegger. The field stage took place in a reference service in the care for people living with HIV, in southern Brazil. From an intentional sample, a phenomenological interview was conducted with 11 couples between August 2013 and April 2014. The analysis was hermeneutic. It was possible to understand, from the meaning units that: couples accept and overcome the serological discordance together; experiencing pregnancy is difficult; there is an effort to have a normal life; the diagnosis is silenced by prejudice and stigma; comes the couple's relief after the child's negative diagnosis. It is necessary to recognize the couple as a unit of care with a view to a non-fragmented care in the field of sexual and reproductive health.

Reproductive planning and pregnancy of HIV serodiscordant couples: a phenomenological study

RESUMO Objetivo: Compreender o vivido do planejamento reprodutivo e da gestação para casais sorodiferentes para o HIV. Método: Estudo qualitativo, na abordagem fenomenológica, referencial teórico-filosófico-metodológico de Martin Heidegger. A etapa de campo foi em serviço de referência na atenção a pessoas soropositivas, no Sul do Brasil. A partir de amostra intencional, foi realizada a entrevista fenomenológica com 11 casais entre agosto de 2013 e abril de 2014. A análise foi hermenêutica. Resultados: Foi possível compreender, a partir das unidades de significação que: os casais se aceitam e superam juntos a diferença sorológica; vivenciar a gravidez é difícil; há empenho para se ter uma vida normal; o diagnóstico é silenciado pelo preconceito e estigma; vem o alívio do casal após o diagnóstico negativo do filho. Conclusão: É necessário reconhecer o casal como uma unidade de cuidado com vistas a uma atenção não fragmentada no campo da saúde sexual e reprodutiva.