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HORIZON HOME
December 18 , 2003

Doctors ponder why some couples have mixed results
By ARTHUR OKWEMBA

When James and his wife walked into one of the VCT (Voluntary
Counselling and Testing) centres to know their HIV status, they were
just going to confirm what they have believed for so many years: they
were HIV negative.

But when the tests were done, the results sent their heads spinning.
James was found to be HIV negative, but his wife, with whom they had
had unprotected sex for over six years, turned out to be HIV
positive.

They did not believe this test, and decided to confirm it with several
other laboratories in different areas. The results remained
invariable: James HIV negative, wife positive.

The counsellor who attended to the couple says they are slowly trying
to come to terms with this devastating and bewildering development.

They are not alone. An increasingly high number of couples are
learning through testing, that despite having unprotected sex for a
long time with their partners, only one of them has the HIV (Human
Immuno-deficiency Virus).

This phenomenon is causing confusion and threatening to break up many
relationships.

But at the same time, notes Dr Surendra Patel who operates a clinic in
Westlands, the partner who has managed to remain negative under the
circumstances is extremely important. .

He or she may provide some of the answers in the development of a
vaccine.

With a similar phenomenon being observed on a large scale in parts of
South Africa, HIV experts believe it is one area where massive
research is going to take place.

Such couples are known as HIV discordant couples, which is a state
whereby two partners, despite having unprotected sex with each other
for along time, one is found to be HIV positive and the other
negative.

The number of discordant couples is increasing as more people open up
for HIV testing.

At Kenyatta National Hospital VCT centre, an estimated 10 to 15 per
cent of the couples who get tested turn out to be discordant.

Dr David Bukusi, the facilities project manager, says even when they
get such results; they do not reveal them to the HIV negative partner
without the consent of the one found to be positive.

"We follow strict guidelines as far as confidentiality is concerned.
The HIV status of a person, no matter how closely one is related to
him or her, can only be revealed with the consent of the person who
has been tested."

Besides, he says, they have to counsel the two partners before
releasing the results to them.

For now, HIV experts are trying to put the dots together to explain to
their clients why only one of them has the virus, which he or she is
not passing to the other.

"One thing that is becoming clear to researchers is that the infected
partner is not getting opportunistic infections despite having the
virus for a long time," says Dr Moses Otsyula, an HIV expert and head
of virology department at the Institute of Primate Research.

Their CD4 counts are not declining (the body�s defence cells whose
level is used to determine when one has to start using ARVs).

And they have very low viral loads (amount of HIV in the body) in
their semen or vagina, which could explain why they are not infecting
the negative partner.

Still, other theories abound. According to Dr Patel, one of the many
other theories is that the HIV negative partner is believed to produce
particular anti-bodies known as chemokinines, which prevents him or
her from getting infected by the positive partner.

For women, new research is showing that the so-called microphage cells
found on the lining of their vagina, maybe the answer behind their
protection. These cells are the sites or receptors used by the HIV
virus to enter a person�s blood cells.

It has been suggested that women with a lot of mucus in their vagina
offer a heavy protective gear to these cells, making it difficult for
the HIV virus to reach and infect them. and infect a person.

Others are said to prevent infection by means that remain
controversial. They have a form of bacteria known as lactobacillus,
which exists naturally in their virginal tract.

This lactobacillus makes the virginal environment acidic, which kills
the HIV virus once it comes into contact with it.

But in many women, such an acidic environment is lacking, and the
researchers believe they can introduce this strain of the bacteria
into the woman to boost the acidic environment.

Likewise, it is believed, some women have Killer-T cells, which
protect them from infection. Incidentally, this is the same
information used by Kenyan and British researchers to develop a
vaccine, which is now moving to phase two of the trials.

In the Kenya Aids Vaccine Initiative case, commercial sex workers in
Majengo slums were found to remain HIV negative even after having
unprotected sex with infected men.

Later research on the women found that they had particular anti-bodies
known as Killer T-cells, which protect them from HIV infection.

Investigations are being carried out on discordant couples where the
woman is HIV negative and the husband is positive. It is still not
clear if the negative partner can hold on forever without getting
infected.

To doctors, without an answer to these theories in sight, their brief
now is to help couples deal with the situation.

Says Dr Patel, who has been dealing with HIV/Aids patients for over 18
years: "It is one of the most tricky things taking place now. The
biggest challenge is to help the negative partner to accept and
support the infected partner."

In his recent observation among his clients, Dr Patel and Dr Otsyula
found that out of 31 couples they tested, 23 were discordant couples.

Some of them have stayed in a sexual relationship with the infected
partner for more than six years without the infected one passing the
virus to the other.

And when these discordant couples brought their children for testing,
all of them were free of the virus.

Doctors like Patel say in such scenario, they have to handle the case
very carefully to pre-empt any violence against the partner who is HIV
positive, especially if it is the woman.

Proper communication and counselling, he says, is very important in
making couples accept what is happening to them.

Some men have been known to engage in a violent break-up of relations,
accusing their wives of promiscuity. However, others haveoffered a
shoulder for their wives to lean on.

One of the counsellors at the Kenyatta hospital VCT, has fresh
memories of a moving case where an HIV negative man agreed to support
his wife of eight years after HIV tests established she had the virus.

"Every time she comes for her sessions in the support groups, he
accompanies her as well as buying her drugs. It is just amazing," says
the counsellor.

Many HIV experts agree that husbands or wives who accept this
phenomenon and support the victim with the virus are very few.

"It is very difficult for people to accept a phenomenon that many
scientists are yet to understand fully," observes Dr Otsyula, an HIV
expert and head of virology department at the Institute of Primate
Research.

Like Ostyula and Patel, doctors who deal with such couples are also
finding it difficult to convince them to use a condom during sexual
intercourse.

Most couples continue having unprotected sex with their infected
partners even after being advised not to do so.

Dr Patel says 50 per cent of the discordant couples they counselled on
safe sex dropped the idea of using the condom after some time.

And in another observation, only one out of the 23 discordant couples
who were advised to use a condom used it. This is worrying Aids
experts.

They argue that the receptor cells (the cells on which the HIV virus
attach on before entering the body cells) in the negative couple may
increase at one point in life, leading to infection.

The other worry is that the HIV negative partner may think he or she
is safe from contracting the virus, and decide to engage in
unprotected sex outside marriage.

This may expose him or her to acquiring other venereal diseases like
gonorrhoea or syphilis.

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