Tuesday, April 26, 2011

Fighting HIV in South Africa should focus on couples

HIV-positive people in South Africa take almost as much risk in their behavior when they know their partner is HIV-negative or don't know their status, as when they know their partner is already infected.

At the same time, HIV-positive partners who are on antiretroviral therapy and in intensive counseling do engage in less risky behavior.

The Brown University researchers who led the study say both findings suggest that more couples-based HIV counseling is needed in South Africa where about 18 percent of adults carry the virus.

"This paper clearly points to the urgent need to intervene among people already infected with HIV and especially those in 'discordant' relationships - relationships in which their partner is not infected," said Mark Lurie, professor of community health and a senior author of the study.

The study surveyed 1,163 sexually active HIV-positive men and women in a primary care program at Chris Hani Baragwanath Hospital in Soweto, near Johannesburg.

In all, about 40 percent of the people surveyed knew their partner was also HIV positive. The same proportion didn't know their partner's status and 20 percent knew their partners to be HIV-negative. There was no correlation between how long the couples were together (a median of 3.4 years) and whether a partner's status was known.

The factor that did seem to be associated with decreased se xual risk-taking behavior was receiving antiretroviral (ART) medication.

Taken together, the prevalence of risk in South African couples and the likely role that counseling plays in curbing risk could add up to a significant potential benefit to increasing couples counseling about HIV. By bringing men and women into counseling together, such programs may help overcome power imbalances between men and women that exacerbate the lack of communication about HIV status in some relationships.

HIV prevention and treatment programs need to be more couples-friendly or family-focused.


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