Sustained effect of couples' HIV counselling and testing on risk reduction among Zambian HIV serodiscordant couples.

Abstract

BACKGROUND:

We present temporal trends in self-reported and biological markers of unprotected sex and sex with concurrent partners in discordant couples receiving couples' voluntary HIV counselling and testing (CVCT).

METHODS:

Heterosexual Zambian HIV-serodiscordant couples were enrolled into longitudinal follow-up in an open cohort (1994-2012). Multivariable Anderson-Gill models explored predictors of self-report and biological indicators of unprotected sex within (including sperm on a vaginal swab, incident pregnancy or incident linked HIV infection) and outside (including self-report, STI and unlinked HIV infection) the union. Measures of secular trends in baseline measures were also examined.

RESULTS:

At enrolment of 3049 couples, men were 35 years old on average, women were 29 years, and couples had been together for an average of 7 years. M+F- couples reported an average of 16.6 unprotected sex acts in the 3 months prior to enrolment (pre-CVCT), dropping to 5.3 in the >0-3 month interval, and 2.0 in >6 month intervals (p-trend <0.001). Corresponding values for M-F+ couples were 22.4 unprotected sex acts in the 3 months prior enrolment, dropping to 5.2 in the >0-3 month interval, and 3.1 in >6 month intervals (p-trend <0.001). Significant reductions in self-report and biological markers of outside partners were also noted. Predictors of unprotected sex between study partners after CVCT included prevalent pregnancy (adjusted HR, aHR=1.6-1.9); HIV+ men being circumcised (aHR=1.2); and HIV- women reporting sex with outside partners (aHR=1.3), alcohol (aHR=1.2), injectable (aHR=1.4) or oral (aHR=1.4) contraception use. Fertility intentions were also predictive of unprotected sex (aHR=1.2-1.4). Secular trends indicated steady declines in reported outside partners and STIs.

CONCLUSION:

Reductions in self-reported unprotected sex after CVCT were substantial and sustained. Reinforced risk-reduction counselling in pregnant couples, couples desiring children and couples with HIV- women having outside partners or using alcohol or injectable or oral contraception are indicated.

• Authors: Kristin M Wall, William Kilembe, Bellington Vwalika, Lisa B Haddad, Shabir Lakhi, Udodirim Onwubiko, Naw Htee Khu, Ilene Brill, Roy Chavuma, Cheswa Vwalika, Lawrence Mwananyanda, Elwyn Chomba, Joseph Mulenga, Amanda Tichacek, Susan Allen
• Journal: Sexually transmitted infections (Sex Transm Infect) Vol. 93 Issue 4 Pg. 259-266 (Jun 2017) ISSN: 1472-3263 [Electronic] England
• PMID: 28082662 (Publication Type: Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Topics

• Adult
• Condoms (statistics & numerical data)
• Contraception Behavior
• Counseling (methods)
• Family Characteristics
• Female
• Follow-Up Studies
• HIV Seropositivity (psychology)
• Heterosexuality
• Humans
• Longitudinal Studies
• Male
• Patient Compliance (statistics & numerical data)
• Risk Reduction Behavior
• Sexual Behavior (psychology)
• Sexual Partners (psychology)
• Zambia