Discordant couples

Outside sexual partnerships and risk of HIV acquisition for HIV uninfected partners in African HIV serodiscordant partnerships

Ndase P, Celum C, Thomas K, Donnell D, Fife KH, Bukusi E, Delany-Moretlwe S, Baeten JM, J Acquir Immune Defic Syndr. 2012 Jan 1;59(1):65-71.

As African countries scale up couples HIV testing, little is known about sexual behaviours and HIV risk for HIV-uninfected partners in known HIV serodiscordant relationships. Ndase and colleagues conducted a prospective study of 3,380 HIV serodiscordant partnerships from 7 African countries. Self-reported sexual behaviour data were collected quarterly from HIV-uninfected partners. The proportion of HIV-uninfected partners reporting sex with their known primary HIV infected partner decreased during follow-up (from 93.5% in the prior month at baseline to 73.2% at 24 months, p<0.001). Simultaneously, an increasing proportion reported sex with an outside partner (from 3.1% to 13.9%, p<0.001). A small proportion (<5%, stable throughout follow-up) reported sex with the infected partner and an outside partner in the same month (concurrent). Unprotected sex was more common with outside partners than with their primary known HIV infected partners (risk ratio 4.6; 95% CI 4.2-5.2). HIV incidence was similar for those reporting sex only with their primary HIV-infected partner compared to those who reported an outside partner (2.87 vs. 3.02 per 100 person-years, p=0.7), although those who had outside partners were more likely to acquire HIV that was virologically distinct from that of their primary partner (p<0.001). For uninfected members of HIV-serodiscordant couples, sex with the infected partner declined as sex with outside partners increased, likely reflecting relationship dissolution and risk shifting from a known infected partner. Risk reduction messages for HIV uninfected partners in serodiscordant partnerships should include strategies to reduce HIV acquisition from outside partners.

For abstract access click here [2]

Editor’s note: HIV-negative people in serodiscordant partnerships rarely have contact with health care providers after receiving their initial HIV-negative test result. As well, little is known about the evolution of sexual practices in serodiscordant couples after they learn their serostatus. This study, analysing data from a herpes suppression trial (the HIV-positive partner also had herpes simplex virus-2 infection) provides useful information about sexual practices both within and outside the couple over time. Sex within couples declined for both men (94% to 73%) and women (92% to 74%) during the 2 years after they learned their results and sex with an outside partner increased for both men (4% to 19%) and women (0.5% to 4%). Of note, when an outside partner was reported by the HIV-negative partner in a quarterly interview there was little concurrency less than 5% reported sex both within and outside the couple in the previous month. There was a steady increase over time for both men and women in the proportions reporting no sexual activity and reporting sexual activity only with outside partners. The most striking finding is low reported condom use with outside partners, reflecting risk perceptions that may not mirror true risk. Of the 21 people reporting outside partners who seroconverted, 18 acquired HIV outside the partnership while of the 130 reporting no outside partners who seroconverted, 105 of these infections could be biologically linked to the seropositive partner. As the scaling up of HIV testing and counselling proceeds, more serodiscordant couples will learn their status an estimated 50% of people living with HIV in sub-Saharan Africa have a partner who is not infected. Tailored counselling for these couples can help them support each other to better perceive their HIV transmission and acquisition risks to protect themselves and others.

Andorra [5]
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