HIV Prevention Strategies Often Overlook Long-Term Couples In Africa, Researchers Say

Main Category: HIV / AIDS
Article Date: 19 Feb 2010 - 4:00 PDT


Insufficient attention to HIV prevention among couples in long-term relationships contributes to the spread of the virus in sub-Saharan Africa, according to scientists presenting research at a recent conference, the Washington Post reports. Researchers at the 17th Conference on Retroviruses and Opportunistic Infections said that African health authorities have focused primarily on HIV-prevention strategies for casual sex encounters and young people.

According to the Post, as HIV testing has become more common in Africa in recent years, some experts have begun to recognize the need to prevent the spread of HIV/AIDS among "discordant couples" -- in which one partner is HIV-positive and the other is negative. For example, one in 10 Kenyan couples is affected by HIV. Both partners are HIV-positive in 40% of those couples, while 60% -- or about 340,000 couples -- include only one partner who is HIV-positive.

The lack of HIV prevention efforts among stable couples is "tragic" and "undoubtedly has resulted in millions of deaths and has produced million of orphans," Rebecca Bunnell, an epidemiologist at the Centers for Disease Control and Prevention who worked in Uganda and Kenya for 14 years, said at the conference.

A major obstacle in addressing the issue is that most people are unaware of their HIV status, and many people in long-term relationships do not get tested because they assume they are at lower risk, the Post reports. In a 2007 study of 16,000 Kenyans ages 15 through 64, 15% of HIV-positive participants were aware of their status. Nine percent of HIV-affected couples were aware of each partner's status, and the rate of condom use among co-habiting couples was about 5%.

Many of Africa's new HIV cases occur among long-term couples. Sixty-five percent of recent infections in Uganda occur in married people. Moreover, deaths from HIV-related illnesses often create new chances for HIV transmission. In Zimbabwe, for instance, 8% to 17% of new HIV cases are attributed to sexual activity among widows or widowers. Other factors that affect the risk for HIV transmission among discordant couples include male circumcision, which is associated with a lower transmission risk, and whether the man or woman is the infected partner, as female-to-male transmission is less likely than male-to-female.

One method for addressing HIV in discordant couples is focusing on couples and partner testing, with a counselor present for when the statuses are revealed. Some experts caution that this strategy could create new challenges to testing, the Post reports. "The message has to be very carefully crafted," Wafaa El-Sadr, a Columbia University researcher who assists in HIV/AIDS prevention campaigns in 14 African countries, said. She added, "You want to encourage people to come as couples, but you never want to turn anybody away just because they come alone" (Brown, Washington Post, 2/18).

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