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Gay Couples at Risk
Highlight From 6th IAS Conference on Pathogenesis, Treatment and Prevention

By Enid Vázquez

November/December 2011

Atlanta researchers found a high rate of HIV in gay male couples who thought both partners were HIV-negative.

"About 20%, or one in five couples, had a serodiscordant status, where one partner is negative and the other is positive," reported lead researcher Dr. Patrick Sullivan during a late breaker presentation. In 3% [three couples], both partners were HIV-positive. Overall, one out of nine men in the study had a previously undiagnosed HIV infection.

Researchers from Atlanta's Emory University were studying HIV testing and counseling in gay male couples as opposed to individuals. They reported looking at couples voluntary counseling and testing (CVCT), which they said has never been tested in gay men, though it is an effective intervention in South African heterosexual couples, shown to have decreased HIV transmission by 50%. All together, said Sullivan, "Couples testing and counseling reached a population of MSM [men who have sex with men] with much higher undiagnosed HIV prevalence than traditional CVCT."

All of these men must have tested negative for HIV within the past year in order to be eligible for the study. The couples needed to have been together for at least three months; half of them were together for more than a year and half were a couple for less than 13 months. According to the team's research abstract, "A couple's testing service attracted men with a high frequency of undiagnosed HIV infection. Men in steady relationships may perceive less need for HIV testing, but according to our data, CVCT may be an important service to engage coupled men for HIV testing."

The team noted that heterosexual couples in South Africa and gay male couples here share two similarities in the epidemic: there is high prevalence and committed partners are a significant driver of HIV infection. In addition, Sullivan noted that some HIV-positive people may be unlikely to disclose a positive status to partners. "In our own work, only about half of MSM report discussing their status or that of their partners before first having sex," Sullivan said. In addition, he said, "Previous research has shown that most U.S. male couples have some agreement about whether outside partners are allowed and if so, under what conditions."

The Emory researchers enrolled 97 couples (194 men). The majority, 77% (150 men) were black, 14% (27) were white, and 5% (9) were Latino, owing to the population served by AID Atlanta, an HIV service organization which helped the researchers enroll participants (good job, AID Atlanta). They pointed out that the results cannot be generalized to other couples. Couples in which men reported being coerced to test or having been subjected to violence were tested separately instead of together. According to the research abstract, "The necessity of exclusionary criteria should be evaluated before the service is routinely provided." The findings are preliminary and the study continued to enroll participants.

The study results came on the heels of a Centers for Disease Control and Prevention (CDC) report on HIV testing for MSM. According to the June 3 issue of Morbidity and Mortality Weekly, in one survey of more than 7,000 men, of the 19% (1,330) of MSM who tested HIV-positive, 44% (585) were unaware of their infection. According to the report, the similar rate of infection found among MSM whether their behavior was considered high-risk or not suggests that more frequent testing of every three to six months "might be warranted among all sexually active MSM, regardless of their risk behaviors." Currently, the recommendation is for high-risk MSM to test this often (those men with multiple or anonymous partners, methamphetamine use, who have sex in conjunction with illicit drugs, or whose partners meet these criteria).

As one caveat, both the Emory researchers and the CDC report noted that HIV testing and status may have been under- or over-reported. Interestingly, at a discussion of the news from IAS, doctors mentioned that they have patients who use HIV testing as a way to disclose their positive status to a new partner.

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