A.5.HIV sero-discordance in couples seeking VCT services in Malawi
by WP Killam, MS Hochgesang, J Aberle-Grasse, W Limbe, D Newman, M Davis
Introduction: Transmission between heterosexual partners accounts for most HIV infections in Africa, and Couples HIV Counseling and Testing (CHCT) is particularly effective in promoting behavior change; however, VCT is rarely attended by couples. The lack of understanding of HIV sero-discordance among couples may contribute to low attendance by couples. This study describes the frequency of sero-discordance among couples presenting in three large urban VCT centers in Malawi and analyzes factors associated with discordance.
Methodology: Client record data were analyzed for all VCT clients who came to the three MACRO VCT centers as a couple from March 2000 to December 2002. A standard client information form was completed at the time of the VCT visit and later coded into an electronic database. Couples were matched using an anonymous, unique couple id code to link partners for analysis.
Results: Of 109,820 client visits, 7,024 (6.4%) were made by 3512 couples. Half (50.5%) were married couples, 40.8% were premarital, and the remaining 8.7% described their relationship as other. Eleven (11.0%) percent of married couples described the marriage as polygamous. In 19.8% of couples, partners were HIV sero-discordant; 66.8% of couples were concordant negative, and 13.4% of couples were concordant positive. Couple HIV serostatus was significantly different across couple types (p<.001). In particular, the percent of concordant positive couples was higher among married (21.3%) compared to premarital (5.9%) couples, whereas, the frequency of discordance was similar. In sero-discordant couples, the woman was more frequently the HIV-infected individual (in 65.5% of discordant couples vs. 34.5%).
Conclusion/Recommendation: Only a small percent of all MACRO clients came as couples, but a relatively large percent of these couples were HIV sero-discordant. As a result of these findings, MACRO is pursuing more intensive examination of partner HIV status during pretest counseling and posttest plans for disclosure and partner testing. MACRO will pilot strategies to increase skills in counseling couples and inform the public about the possibility of HIV discordance and CHCT.