Evolution of Couples' Voluntary Counseling and Testing for HIV in Lusaka, Zambia

Chomba, Elwyn; Allen, Susan; Kanweka, William; Tichacek, Amanda; Cox, Garrett; Shutes, Erin; Zulu, Isaac; Kancheya, Nzali; Sinkala, Moses; Stephenson, Rob; Haworth, Alan

doi:10.1097/qai.0b013e31815b2d67

Cited by 86 publications

(97 citation statements)

References 32 publications

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“…17 More recently, among 8,500 cohabiting couples who sought couple HIV testing in Lusaka, Zambia between 1994 and 2000, it was found that nearly half were discordant, with HIV-positivity equally distributed between the men and the women. 3 These findings suggest the need to reconsider the assumption that HIV infection among cohabiting couples is due only to extramarital sexual activity by men, and the difficulties women encounter in protecting themselves. Obviously, this is a reality for many women, but men are also at high risk of HIV infection as regular partners in countries heavily affected by the epidemic.…”

Section: Methodsmentioning

confidence: 88%

“…But attendance at couple VCT dropped when community outreach ceased, despite continued media advertising. 3 The experiences in Rwanda and Zambia show that door-to-door promotion of couple VCT by well-trained and influential members of the community was needed to overcome the fear of stigma among couples. 38 In addition to the couple VCT programmes described in the literature, two others were based in PMTCT programmes, one in Zambia and the other in Kenya (Table 2).…”

Section: Couple-centred Approaches To Hiv Counselling and Testingmentioning

confidence: 99%

“…On the same day, each couple received joint confidential post-test counselling. 3,14,38 In a multi-site couple VCT efficacy study in Kenya, Tanzania and Trinidad, the process was slightly different: when couples arrived for VCT at a health centre, the couple were counselled together or individually, by their own choice. Some individual time with a counsellor was given to ensure accurate risk assessment.…”

Section: Couple-centred Approaches To Hiv Counselling and Testingmentioning

confidence: 99%

“…Yet many studies have shown that a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. [3][4][5] It has also been assumed that it is more difficult to adopt preventive behaviours with a regular partner than with an occasional partner, and the difficulties women face to have protected sex in a marital relationship have been described. 6,7 Recent studies show that it may also be difficult for men to negotiate protection within the couple too.…”

mentioning

confidence: 99%

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Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa

Loû¹,

Orne-Gliemann²

2008

Reproductive Health Matters

101

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In Africa, a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. In five African countries at least two-thirds of couples with at least one HIV-positive partner were HIV serodiscordant; in half of them, the woman was the HIV-positive partner. Hence, there is an urgent need to define strategies to prevent HIV transmission within couple relationships. HIV counselling and testing have largely been organised on an individual and sex-specific basis, for pregnant women in programmes for prevention of mother-to-child transmission of HIV and in STI consultations and recently male circumcision for men. A couple-centred approach to HIV counselling and testing would facilitate communication about HIV status and adoption of preventive behaviours within couples. This paper reviews what is known about HIV serodiscordance in heterosexual couples in sub-Saharan Africa and what has been published about couple-centred initiatives for HIV counselling and testing since the early 1990s. Despite positive outcomes, couple-oriented programmes have not been implemented on a large scale. In order to stimulate and strengthen HIV prevention efforts, increased attention is required to promote prevention and testing and counselling for couples in stable relationships.

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Section: Methodsmentioning

confidence: 88%

Section: Couple-centred Approaches To Hiv Counselling and Testingmentioning

confidence: 99%

Section: Couple-centred Approaches To Hiv Counselling and Testingmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa

Loû¹,

Orne-Gliemann²

2008

Reproductive Health Matters

101

View full text Add to dashboard Cite

show abstract

“…If both members of the couple do not receive VCT, the individual may not disclose their serostatus [4,5] and protect an uninfected partner or restrict transmission of potentially resistant virus between infected partners [6]. Couples VCT (CVCT) has been the most successful HIV prevention approach for couples in Africa [7,8], but strategies are needed to assess and maintain post CVCT risk reduction among large numbers of couples over time [9] at the community level.…”

Section: Introductionmentioning

confidence: 99%

Community-Based Risk Reduction in Zambia

Rodriguez¹,

Weiss²,

Waldrop‐Valverde³

et al. 2008

TOHSPJ

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Abstract:Following the trial of a sexual risk reduction intervention conducted at the University Teaching Hospital (UTH) in Lusaka, Zambia, this pilot study sought to evaluate the feasibility of conducting the intervention at the Community Health Center (CHC) level. UTH staff implemented assessments and the intervention while CHC staff provided logistic and administrative support. HIV seropositive women (CHC n = 200; UTH n = 612) attended group sessions in which male partners were randomized to a three-session or one-session group intervention arm. At baseline, consistent use of male and female condoms differed between sites (HIV+ UTH, 73%, CHC, 88%, HIV-UTH, 42%, CHC 65%); both sites increased combined condom use at 6 months post baseline and maintained increases over baseline at 12 months. Participants did not differ between sites at baseline on condom attitudes, HIV knowledge or self efficacy. At 12 months post baseline, both sites had improved in attitudes, knowledge and efficacy and participant retention was lower at the UTH site (77% versus 82%). Inconsistent sexual barrier users increased to consistent use at both sites after 6 months (HIV positive UTH, 96%, CHC, 99%, HIV negative UTH, 84%, CHC 100%). At 12 months, HIV negative CHC participants maintained higher levels of condom use in comparison with UTH participants (F = 7.17, p = .001). Results illustrate the feasibility and efficacy of conducting group sexual risk reduction interventions in the Zambian community, and the potential for the use of group interventions in conjunction with existing CHC Voluntary Counseling and Testing (VCT) programs.

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Spousal Intimate Partner Violence is Associated with HIV and Other STIs Among Married Rwandan Women

Dude

2009

AIDS Behav

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HIV is a health problem in Rwanda, where the adult HIV prevalence is 3.1% (WHO 2008 in Online database of HIV/AIDS epidemiological data, found at: http://www.who.int/globalatlas ); the majority of those infected are women (UNAIDS 2008 in http://data.unaids.org/pub/Report/2008/rwanda_2008_country_progress_report_en.pdf ). Prior studies indicate that intimate partner violence is frequently associated with increased HIV risk in women, often because men who abuse their wives also exhibit riskier sexual behaviors (Silverman et al. in JAMA 300:703-710 2008. Population-based data from the 2005 Rwanda Demographic and Health Survey indicate that women with few, if any, other sexual risk factors who have experienced sexual, physical, or emotional abuse within their marriages are 1.61-3.46 times as likely to test positive for HIV, and 2.14-4.11 times more likely to report another STI. These findings confirm prior clinical studies that indicate that intimate partner violence is a correlate of HIV/STIs in Rwanda. Further research is needed to determine whether Rwandan men that abuse their wives have higher baseline rates of HIV/STI infection.

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Evolution of Couples' Voluntary Counseling and Testing for HIV in Lusaka, Zambia

Abstract: : Many married African adults do not have high-risk profiles, nor realize that only 1 may be HIV positive. Active and sustained promotion is needed to encourage all couples to be jointly tested and counseled.

Cited by 86 publications

References 32 publications

Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa

Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa

Community-Based Risk Reduction in Zambia

Spousal Intimate Partner Violence is Associated with HIV and Other STIs Among Married Rwandan Women

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