The reasons behind the differences in the levels of discordancy (that is one partner testing HIV positive while the other testing HIV negative) among spousal and cohabiting partnerships affected by HIV across sub-Saharan Africa (SSA) remain inadequately understood. Recently, many randomized clinical trials have shown substantial efficacies for several prevention interventions among these partnerships.

Moreover, there has been an intense debate about the priority of HIV prevention interventions among discordant couples relative to other prevention approaches such as among commercial sex networks.

To describe and explain patterns of HIV infection among spousal and cohabiting sexual partnerships, across a range of settings in SSA.

Demographic health survey (DHS) data for 20 countries in SSA were used to estimate the prevalence of HIV sero-discordancy among stable partnerships with at least one HIV-infected individual in the partnership (P), prevalence of discordancy among all stable partnerships in the population (S), prevalence of discordancy among the entire sexually active population (A), and prevalence of discordancy among HIV infected individuals (I).

Two distinct patterns of HIV among stable partnerships were observed. Countries with low HIV prevalence had a high discordancy prevalence among P and I ranging from 48.4–87.8% and 30.6–60.0%, respectively, but low discordancy prevalence among S and A ranging from 0.4–6.4% and 0.2–3.8%, respectively. Conversely, countries at hyper-endemic HIV epidemics had a low discordancy prevalence among P and I ranging from 36.3–58.5% and 17.2–46.0%, respectively, but high discordancy prevalence among S and A ranging from 9.3–17.2% and 5.8–8.3%, respectively.

Two distinct patterns of HIV in stable partnerships were observed. In high prevalence settings, many partnerships were affected by HIV but relatively few were discordant, whilst the opposite was true for low prevalence settings. This pattern may be arising from variations in the HIV transmission probability which is dependent on biological and behavioral factors and might also be affected by the frequency of infection from external partners especially in high prevalence countries. These findings may complicate considerations for rolling out prevention interventions among stable discordant partnerships in SSA.


Article metrics loading...

Loading full text...

Full text loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error