Rosenberg, N.E., Graybill, L.A., Wesevich, A., et al. Journal of Acquired Immune Deficiency Syndromes (April 2017), e-publication ahead of print, doi:10.1097/QAI.0000000000001398.
In sub-Saharan Africa, couples HIV testing and counseling (CHTC) has been associated with substantial increases in safe sex, especially when at least one partner is HIV-positive. This observational study, conducted in an antenatal clinic in Lilongwe, Malawi, examined CHTC in the context of an Option B+ program. In 2016, the authors interviewed heterosexual pregnant couples (90 female-positive and 47 female-negative, including both seroconcordant and serodiscordant couples). They provided condoms and information about their use and assessed their behavior just before and one month after CHTC, focusing on safe sex (abstinence or consistent condom use in the last month). The authors then modeled changes in safe sex before and after CHTC and compared reports of safe sex between female-positive and female-negative couples. Before CHTC, safe sex was comparable between female-positive couples (8%) and female-negative couples (2%). One month after CHTC, reported safe sex increased markedly among female-positive couples, to a prevalence of 75 percent, compared to 3 percent among female-negative couples. Serodiscordant couples in both groups reported nearly universal condom use after CHTC. The authors concluded that engaging pregnant couples in CHTC can have prevention benefits for couples with an HIV-positive pregnant woman, but additional prevention approaches may be needed for couples with an HIV-negative pregnant woman.