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Couples HIV Testing and Counselling Prompts Rapid Switch to Consistent Condom Use in South African Study

December 7, 2012

Researchers report that HIV testing and counseling of couples resulted in consistent condom use among sero-discordant couples in stable relationships in South Africa. The study determined whether HIV testing and counseling (HTC)—with ongoing counseling and condom distribution—resulted in reduced unprotected sex in HIV-discordant couples who are in stable relationships.

Participants were part of the Partners in Prevention HSV/HIV transmission study to assess acyclovir as a secondary prophylaxis in HIV/HSV-2 co-infected persons to prevent transmission to their uninfected partner. The 508 HIV-infected participants self-reported behavioral data. They were from three South African sites: Gugulethu, Orange Farm, and Soweto. Most of the couples were in long-term relationships with low levels of intimate partner violence. The HIV-positive participants were predominantly female (77 percent), with a mean age of 33 years.

The important factor in the study was the timing of HTC for the HIV-positive participant: 0?7 days after testing positive, 8?14, 15–30, and more than 30 days. The primary outcome was unprotected sex reported by the person with HIV. Predicted probabilities of unprotected sex in the last month were calculated at baseline, at one month, and at 12 months. Of the participants, 71 percent who recently learned their HIV status reported having unprotected sex as compared to 25 percent who knew their status for a month. One month later, after all the couples had received HIV testing and counseling and were aware of the discordant relationship, the proportion of participants reporting unprotected sex was reduced from 71 percent to 8 percent.

Monthly counseIing for the sero-positive partner, quarterly individual or couples' testing, counseling for the uninfected partner, and condom provision resulted in the couples maintaining low levels of unprotected sex for one year. The authors conclude that the findings provide evidence that couples HTC is effective at rapidly increasing condom uptake, facilitating on-going condom use, and lowering rates of transmission. They advise caution in generalizing the findings to other than stable relationships.

The study, "HIV Testing and Counseling Leads to Immediate Consistent Condom Use Among South African Stable HIV-Discordant Couples," was published ahead of print in the Journal of Acquired Immune Deficiency Syndrome (doi: 10.1097/QAI.0b013e31827971ca).

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Excerpted from:
12.05.2012; Carole Leach-Lemens

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