Benefits of targeting prevention at attendees of HIV testing services, Brazil

Efficient identification of HIV serodiscordant couples by existing HIV testing programs in south Brazil.

Pilcher CD, Bisol CA, Paganella MP, Vallabhaneni S, da Motta LR, Kato SK, Sperhacke RD, Kallas EG, Hecht FM, Diaz RS. PLoS One. 2015; 10(11): e0142638. Published online Nov 12.

Objective: To examine the feasibility of identifying HIV negative at risk individuals in HIV serodiscordant couples, during voluntary HIV testing in South Brazil.

Methods: We surveyed HIV testers at 4 public testing sites in Rio Grande do Sul. We obtained information on risk behaviors and sexual partnerships. HIV testing and testing for recent infection were performed; HIV prevalence and risk behaviors were assessed among subjects who reported having a steady partner who was HIV positive (serodiscordant group) and compared with the general testing population.

Results: Among 3100 patients, 490 (15.8%) reported being in a steady relationship with an HIV positive partner. New HIV infections were diagnosed in 23% of the serodiscordant group (vs. 13% in the general population, p = 0.01); among newly positive subjects, recent HIV infections were more frequent (23/86, 26.7%) among testers with positive partners than among the general testing group (52/334; 15.6%; p = 0.016). Less than half of the serodiscordant testers reported having used a condom during the last sexual intercourse with their HIV-positive partner. Participants with inconsistent condom use with steady partner were four times more likely to test positive for HIV compared to those who reported always using condoms with the steady partner (OR: 4.2; 95% CI: 2.3 to 7.5).

Conclusion: It is highly feasible to identify large numbers of HIV susceptible individuals who are in HIV serodiscordant relationships in South Brazil testing sites. Condom use within HIV serodiscordant couples is low in this setting, suggesting urgent need for biomedical prevention strategies to reduce HIV transmission.

Abstract Full-text [free] access

Editor’s notes: This study from Brazil highlights the fact that asking individuals attending HIV testing services whether they had a steady partner living with HIV can identify a large number of key populations who should be an important focus for HIV prevention services. In this study, a striking proportion (15%) of testers reported that they were in a serodiscordant relationship with an individual living with HIV. This provides an important opportunity to link these key populations to proven prevention services, including medical male circumcision and pre-exposure prophylaxis. There was also clear evidence that these individuals are at high risk of HIV, e.g. they were almost twice as likely to have an acute HIV infection compared with testers with “general population” partners. This suggests that individuals in serodiscordant relationships sought HIV testing services when they thought they had been exposed to a high risk sexual event. The paper does not report the treatment status of the partners living with HIV and it is not clear if participants were asked about this. The authors conclude that it is feasible to identify HIV susceptible individuals at testing sites. It is also important to remember that this is not only to focus on people with a partner living with HIV, but also all people testing HIV-positive. People in the latter group are a key population for prevention too, as they are at risk for transmitting HIV within their steady partnership which was previously concordant HIV-negative.

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