Couples counseling and testing addresses HIV prevention in Africa

Offering married couples in sub-Saharan Africa joint HIV counselling and testing could curb the spread of sexually transmitted HIV in those regions by up to 60 percent, a new study finds.

The paper, published in the June 28, 2008 issue of the journal Lancet, notes that joint Voluntary Counselling and Testing (VCT) of couples in urban Rwanda and Zambia could be as effective at HIV prevention for both women and men as circumcision is for men.

"Marriage is increasingly recognised as a potentially high-risk setting for heterosexual HIV transmission, especially for women, but this is the first attempt we are aware of to estimate the total burden of HIV attributable to marital transmission," says study author Kristin Dunkle, PhD, MPH, an assistant professor of behavioural science and health education at Emory University’s Rollins School of Public Health.

Dunkle and a team of Emory public health and African-based researchers used population-based Demographic and Health Survey data on sexual behaviour. They also used data from Emory’s Rwanda Zambia HIV Research Group on the joint HIV status of married or cohabiting couples and non-cohabiting couples in Lusaka, Zambia, and Kigali, Rwanda.

Researchers estimated the probability that an individual would acquire HIV infection from a marital/cohabiting partner or a non-cohabiting partner, and then the proportion of total heterosexual HIV transmission that likely occurs within married or cohabiting couples in these settings each year.

The study found that 55 percent to 93 percent of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda take place within marriage and cohabitation. Providing Voluntary Counselling and Testing to these couples could avert 36 percent to 60 percent of HIV infections that would otherwise occur.

"Traditional approaches to HIV prevention such as promoting abstinence and fidelity are clearly inadequate and inappropriate," Dunkle says. "Marriage can and does place both women and men at high risk for HIV infection, and we need prevention strategies that directly address that reality."

Dunkle and team call for increased promotion of couples-based voluntary counselling and testing as well as development of other evidence-based, culturally and gender-sensitive interventions targeting heterosexual couples.

(Source: Lancet: Emory University: July 2008)