HIV-1-Discordant Couples in Sub-Saharan Africa: Explanations and Implications for High Rates of Discordancy

Guthrie, Brandon L.; Bruyn, Guy de; Farquhar, Carey

doi:10.2174/157016207781023992

Cited by 125 publications

(73 citation statements)

References 89 publications

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“…This may be due to the relatively higher frequency of sex in newer relationships [21, 22]. Additionally, partners who stay negative after longer periods of time in a serodiscordant relationship may have reduced susceptibility of some kind, such as having a protective genetic predisposition or acquired immunity through repeated exposure [23]. In any case, this finding suggests that in Opposites Attract , men in new relationships need to be targeted to ensure that the effect of ART on transmission can be measured.…”

Section: Discussionmentioning

confidence: 99%

The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods

et al. 2014

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BackgroundStudies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments and undetectable viral load in reducing the risk of HIV transmission. There is very limited data on the risk of transmission from anal sex in homosexual male serodiscordant couples.Methods/DesignThe Opposites Attract Study is an observational prospective longitudinal cohort study of male homosexual serodiscordant partnerships running from 2012 to 2015 and conducted in clinics throughout Australia, Brazil and Thailand. Couples attend two or more clinic visits per year. The HIV-positive partner’s viral load is tested and the HIV-negative partner is tested for HIV antibodies at every clinic visit. Results from any tests for sexually transmitted infections are also collected. Detailed behavioural questionnaires are completed by both partners at the time of each visit. The primary research question is whether HIV incidence is lower in those couples where the HIV-positive partner is receiving HIV treatment compared to couples where he is not receiving treatment. A voluntary semen sub-study will examine semen plasma viral load in a subsample of HIV-positive partners in Sydney, Rio de Janeiro and Bangkok. In cases of seroconversion of the initially HIV-negative partner, phylogenetic analysis will be conducted at the end of the study on virus from stored blood samples from both partners to determine if the infection came from the HIV-positive study partner. Men in new serodiscordant relationships will specifically be targeted for recruitment.DiscussionThis study will provide critical data on the reduction in HIV transmission risk associated with being on HIV treatment in homosexual male serodiscordant couples in different regions of the world. Data from men in new relationships will be particularly valuable given that the highest transmission risk is in the first year of serodiscordant relationships. Furthermore, the detailed behavioural and attitudinal data from the participant questionnaires will allow exploration of many contextual factors associated with HIV risk, condom use and the negotiation of sexual practice within couples.

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Section: Discussionmentioning

confidence: 99%

The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods

et al. 2014

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“…Heterosexual transmission among discordant couples in marriage or cohabitation accounts for most of the HIV incidence in this region [2] [3–6]. In sub-Saharan Africa, in studies where both members of the couple have been tested, rates of serodiscordance range between 1–7% [4, 5, 7–9] and 10–25% of new HIV infections occur among HIV-discordant couples [10]. In a study of five African countries using Demographic Health Survey (DHS) and AIDS Indicator Survey (AIS) data, de Walque found that among 9,297 infected persons, more than two thirds were in serodiscordant relationships [11].…”

Section: Introductionmentioning

confidence: 99%

“I Do Not Take My Medicine while Hiding” - A Longitudinal Qualitative Assessment of HIV Discordant Couples’ Beliefs in Discordance and ART as Prevention in Uganda

King¹,

Kim²,

Nanfuka³

et al. 2017

PLoS ONE

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BackgroundHIV negative members of serostatus discordant couples are at high risk for HIV acquisition, but few interventions are in place to target them in sub-Saharan Africa.MethodsIn this study, we interviewed 28 couples, 3 times over a period of one year to understand their perceptions and attitudes around discordance, their relationship dynamics, their HIV risk behaviour, their beliefs and attitudes about antiretroviral therapy (ART) and their views of the community perceptions of discordance and treatment for HIV.ResultsFindings revealed that at baseline there were multiple complex explanations and interpretations about discordance among discordant couples and their surrounding community. Shifts in beliefs and attitudes about discordance, HIV risk reduction and ART over time were enabled through re-testing negative members of discordant couples and repeat counselling but some beliefs remain solidly embedded in cultural imperatives of the importance of childbearing as well as culturally determined and enforced gender roles.ConclusionsInterventions that aim to target discordant couples must embrace the complex and dynamic understandings of HIV diagnosis and treatment in context of fluid relationships, and changing beliefs about HIV risk and treatment.

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“…WHO has issued guidance for couples HIV testing and counseling (CHTC) 4 , which has been used effectively with heterosexual couples in Africa 5-8 . Findings suggest this is a promising strategy for prevention among same-sex male couples 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples

Starks

Tuck²,

Millar

et al. 2015

AIDS Behav

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The purpose of the current study was to examine whether syndemic stress in partnered gay men might undermine communication processes essential to the utilization of negotiated safety and other harm reduction strategies that rely on partners’ HIV status disclosure. Participants included 100 gay male couples (N = 200 individuals) living in the U.S., who responded to an online survey. Participants completed measures of five syndemic factors (depression, poly-drug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity). They also reported on whether condoms were used during first intercourse together and the timing of first condomless anal intercourse (CAI) relative to HIV disclosure in their relationship. Results of binary logistic regression analyses supported the hypothesis that the sum of partners’ syndemic stress was negatively associated with condom use at first intercourse and with HIV disclosure prior to first CAI. Syndemic stress may contribute to HIV transmission risk between main partners in part because it accelerates the progression to CAI and interferes with communication processes central to harm reduction strategies utilized by gay men in relationships. Implications for prevention strategies and couples interventions, such as couples HIV counseling and testing, that facilitate communication skill-building, are discussed.

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HIV-1-Discordant Couples in Sub-Saharan Africa: Explanations and Implications for High Rates of Discordancy

Cited by 125 publications

References 89 publications

The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods

The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods

“I Do Not Take My Medicine while Hiding” - A Longitudinal Qualitative Assessment of HIV Discordant Couples’ Beliefs in Discordance and ART as Prevention in Uganda

Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples

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