Emerging Areas: HIV Prevention for Serodiscordant Couples

Published: November 1, 2009

I. Definition of the prevention area

HIV-serodiscordant couples, in which one partner is HIV-positive and the other HIV-negative, are increasingly recognized as a priority for HIV prevention interventions.

II. Epidemiological justification for the prevention area

Although there is considerable variation across countries, recent studies in sub-Saharan countries with mature epidemics show that up to two-thirds of infected couples are discordant. Among discordant couples, only the female partner is infected in 30 to 40 percent of cases, dispelling a common misperception that only men, not women, engage in extramarital sex.

High infection rates, largely due to heterosexual transmission in sub-Saharan Africa, have spurred efforts to assess the extent of HIV transmission within marriages. One study found that 55 to 92 percent of new, heterosexually acquired HIV infections among adults occurred within serodiscordant marital or cohabiting relationships.

According to a research review, the following factors make it more likely that a person living with HIV will transmit the virus to his or her partner: the presence of other sexually transmitted infections, particularly genital ulcerative diseases; high viral load; failure to use condoms correctly and consistently; and specific sexual practices such as a high number of sexual partners and higher frequency of sexual contact. Concurrent sexual partnership may also contribute to risk. The risk of transmission is especially high during early infection, when it is estimated to be 26 times more infectious than during later stages of infection. This makes it especially important to identify HIV infection during the acute stage.

Prevention responses also need to take into account the progress of the epidemic. One hypothesis is that in early epidemics, most discordant couples occur when HIV is introduced into a pre-existing relationship, whereas in more mature epidemics, a greater proportion of discordant couples initiate relationships with a new partner who is already infected.

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