Insufficient support for HIV-discordant couples
DATE: 1 April 2009
Exploring coping strategies and life choices made by HIV-discordant couples in long-term relationships: 
Insights from South Africa, Tanzania and Ukraine
Durban - The needs of HIV-discordant couples (i.e. where one partner is HIV positive and the other HIV negative) have received insufficient attention in the research and policy agenda. Discordant couples ought to be provided with sexual and reproductive health services in a supportive and non-discriminatory environment; and should be engaged in the HIV response.
These were the main conclusions reached by a team of researchers from the Centre for Health Policy at the University of the Witwatersrand and the Human Sciences Research Council (HSRC), presented here at the 4th South African AIDS Conference.
The researchers conducted an exploratory study to assess sexual health, reproductive desires, strategies for preventing HIV transmission to the negative partner, and sexual and reproductive health service needs of HIV serodiscordant couples in long-term relationships. The research was commissioned by the Global Network of People Living with HIV (GNP+), an advocacy organisation for people living with HIV.
The purpose of the study was to inform GNP+'s wellness, positive living, HIV prevention and advocacy programmes for people living with HIV. The research focused on discordant couples because many HIV infections occur between couples in established relationships, particularly in sub-Saharan Africa, and there has been inadequate attention paid to the needs of couples living in discordant relationships. Most interventions for HIV prevention, treatment, care and support are directed at individuals and there are few interventions for couples. One of the key challenges for HIV discordant couples is minimising the risk of HIV transmission to the negative partner and to any children conceived.
The study was conducted in South Africa and Tanzania, where HIV is transmitted mostly through heterosexual intercourse, and the Ukraine, where HIV is transmitted largely through injection drug use. The researchers recruited 51 couples, in which one partner was HIV-positive and the other HIV-negative, and who had been in a relationship for at least one year. These couples were recruited through health-care providers and civil society organisations in South Africa (26 couples), Tanzania (10 couples), and the Ukraine (15 couples).
Brief self-administered questionnaires and in-depth semi-structured individual and couple interviews were used to study health and wellness management, strategies for reducing the risk of transmitting HIV to the negative partner, parental status and reproductive intentions, and treatment, care and support needs.
The study found that just over half (51%) the couples and almost half (47%) of the HIV-positive individuals in the study desired a child or children. Among individual participants, almost three-quarters (74%) of those without children desired children, while just over one third (36%) those with children desired additional children. Three out of every five participants (61%) reported that intimacy had been affected by their discordant relationship, with changes in sexual relations due to fear of infecting the negative partner and the need for condom use. The desire to avoid infecting the negative partner often conflicted with the desire for children.
In South Africa and Tanzania combined, 43% of the HIV-positive participants reported having experienced some form of discrimination compared to 24% of the HIV-negative participants. Experiences of discrimination were reported more frequently by Tanzanian participants than by South African participants. Several Ukrainian participants reported discrimination from health-care professionals.
Participants reported that there was a shortage of information, educational materials, and support services for discordant couples, with less than half (45%) having participated in a support group in the past year.
Recommendations
The researchers recommend that recognising HIV discordance and addressing the needs of discordant couples should form an integral part of global and national responses to the HIV epidemic. The greater involvement of people living with HIV, which is widely recognised as a key principle in the HIV response, should include involvement of discordant couples. They also recommend that epidemiological information on discordance be collected as part of routine HIV surveillance, and that further research be conducted on the reproductive, information, and social service needs of discordant couples.
The high proportion of HIV-positive individuals and discordant couples who desire children reveal a need for explicit HIV policies recognising the reproductive rights of people living with HIV, and respect for the choice of individuals and couples who desire children. Reported experiences of stigma and discrimination reveal a need for interventions to address stigma and discrimination. There is also a need to educate and orientate health-care professionals to the needs of couples.
Policies and programmes for discordant couples should promote the health of both partners, and provide support in addressing the challenges of being in a discordant partnership. Appropriate services for couples need to be implemented with counselling and service interventions that provide safe reproductive options for HIV discordant couples, advice on strategies to prevent HIV transmission, health education and information on healthy living, couples counselling and testing services, and support groups for discordant couples.
An information leaflet with additional information on the study is available for download:
An exploratory study of coping strategies and life choices made by HIV-discordant couples in long-term relationships:
Visit the HSRC's Social Aspects of HIV/AIDS and Health (SAHA) website
Contact:
• For assistance to set up interviews, call Ina van der Linde, HSRC Media Liaison on 082 331 0614 (ivdlinde@hsrc.ac.za)
• Professor Laetitia Rispel on 082 372 0548 (Laetitia.rispel@wits.ac.za)
• Dr Carol Metcalf on 082 302 8882 (cmetcalf@hsrc.ac.za).