Sustained Effect of Couples' HIV Counseling and Testing on Risk Reduction among Zambian HIV Serodiscordant Couples

March 2017 - Combination Prevention

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Wall, K.M., Kilembe, W., Vwalika, B., et al. Sexually Transmitted Infections (January 2017), pii: sextrans-2016-052743, doi:10.1136/sextrans-2016-052743, e-publication ahead of print.

This study examined the impact of couples' voluntary HIV counseling and testing (CVCT) services on sexual risk behavior in a cohort of HIV-serodiscordant heterosexual couples in Zambia. The study enrolled 3,049 heterosexual Zambian HIV-serodiscordant couples (M+F−, M−F+) with longitudinal follow-up over time (1994–2012); and compared self-reported and biological markers of unprotected sex. The findings showed substantial reductions in self-reported unprotected sex after CVCT among participants:

  • M+F– couples reported an average of 16.6 unprotected sex acts in the three months before enrollment, which dropped to 5.3 in the >0–3-month interval, and 2 in >6-month intervals.
  • M−F+ couples reported 22.4 unprotected sex acts in the three months before enrollment, dropping to 5.2 in the >0–3 month interval, and 3.1 in >6-month intervals.

Neither group showed evidence of relapse in these risk behaviors over time. The study also showed significant reductions in self-report and biological markers of outside partners. However, almost 40 percent of couples continued to have some indicator of unprotected sex, highlighting the need for targeted risk reduction counseling (especially for pregnant couples, those wanting children, and those in which HIV– negative women have outside partners or use alcohol or injectable or oral contraception). These results supported the World Health Organization’s recommendation to provide joint HIV testing and counseling for prevention.

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