Medley, A., Baggaley, R., Bachanas, P., et al. AIDS Care (May 2013). E-publication ahead of print.
The authors described HIV interventions that should be offered to couples, both in generalized and concentrated epidemics, to decrease the risk of transmission to HIV-negative partners and children and to support HIV-positive partners in accessing necessary HIV services. An emphasis on couples-focused HIV services, rather than traditional, individual HIV services, is urgently needed, and could potentially reduce population-level HIV incidence. This article complements the World Health Organization’s couples HIV testing and counseling (CHTC) guidelines. Interventions appropriate for couples included antiretroviral treatment (ART) for the HIV-positive partner; ART adherence counseling and support; risk reduction counseling (including supplying condoms); linking HIV-positive mothers with services for prevention of mother-to-child transmission; counseling on family planning and safer contraception and pregnancy; pre-exposure prophylaxis treatment for the HIV-negative partner; voluntary medical male circumcision for the HIV-negative male partner in serodiscordant relationships; screening and treatment for sexually transmitted infections; and routine HTC for HIV-negative partners or for HIV-negative couples in high-prevalence contexts. Reaching and engaging men in HIV prevention, care and treatment services will be critical to the scale-up of couple-focused HIV interventions, the authors said. Also, because of reported high rates of intimate partner violence (IPV) and the potential barriers they create for access and utilization, health care workers should be aware of and trained to screen for and address IPV.