The social dynamics of HIV transmission as reflected through discordant couples in rural Uganda.
ABSTRACT To describe the role of men and women as sources of HIV transmission and to estimate HIV incidence among discordant couples resident in diverse rural communities in Uganda.
Rakai, a rural district in Uganda, East Africa.
A population-based cohort study, which has been conducted as annual serological and behavioral surveys since 1989. Community clusters were stratified into trading centers on main roads, intermediate trading villages on secondary roads and agricultural villages off roads. In the 1990 survey round, serological data were available for 79 discordant and 411 concordant HIV-negative couples aged 13-49 years. The present analysis examines sex-specific seropositivity associated with place of residence and the incidence of seroconversion among discordant couples between 1990 and 1991.
Seventy-nine discordant couples were followed; the HIV-positive partner was male in 44 couples (57%) and female in 35 couples (43%). There was marked variation in the sex of the seropositive partner by place of residence: women were the HIV-positive partner in 57% of couples from trading centers, 52% from intermediate villages, and 20% from agricultural communities (P < 0.008). Condom use was higher in discordant couples in which the man was the uninfected partner (17.1%) rather than the woman (9.5%). HIV-positive women, but not HIV-positive men, reported significantly more sexual partners and more genital ulcers than seronegative individuals of the same sex. Seroincidence rates among men and women in discordant relationship were 8.7 and 9.2 per 100 person-years (PY), respectively, which was much higher than in concordant seronegative couples (men, 0.82; women, 0.87 per 100 PY).
In this Ugandan population, men are the predominant source of new infections in rural villages. Risk factors and preventive behaviors vary with the sex of the infected partner, and seroconversion rates are similar in both sexes.
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ABSTRACT: During the initial survey (April 1999-January 2000) of an ongoing Community HIV Epidemiological Research (CHER) study, adults aged 15-49 years in 56 study communities were enrolled into the study. Knowledge, Attitude, Behaviour, Practice questionnaires were administered and blood was obtained from 77.6%. HIV testing was performed using two different enzyme immunosorbent assays with Western blot confirmation of discordant results and first time positives. All those who gave blood had free and unlimited access to voluntary counselling and testing (VCT), and were free to participate as individuals or couples. HIV results were provided in people's homes by trained and certified project resident counsellors. Ninety per cent of those who were bled requested their HIV results, while 64.6% of those who requested their HIV results received them. The proportion of people receiving HIV results has almost doubled in the last 6 years (1994-2000) from about 35% in 1994/1995 to 65% in 1999/2000. These data indicate high proportions of acceptance and receipt of VCT in this rural population-based cohort, suggesting that home delivery of VCT could offer a unique opportunity for people in the rural areas to access counselling and testing services, given adequate resources.Tropical Medicine & International Health 01/2003; 7(12):1064-7. DOI:10.1046/j.1365-3156.2002.00964.x · 2.30 Impact Factor
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ABSTRACT: Most HIV infections in sub-Saharan Africa occur during heterosexual intercourse between persons in couple relationships. Women who are infected by HIV seropositive partners risk infecting their infants in turn. Despite their salience as social contexts for sexual activity and HIV infection, couple relationships have not been given adequate attention by social/behavioral research in sub-Saharan Africa. Increasingly studies point to the value of voluntary HIV counseling and testing (VCT) as a HIV prevention tool. Studies in Africa frequently report that VCT is associated with reduced risk behaviors and lower rates of seroconversion among HIV serodiscordant couples. Many of these studies point out that VCT has considerable potential for HIV prevention among other heterosexual couples, and recommend that VCT for couples be practiced more widely in Africa. However, follow-up in the area of VCT for couples has been extremely limited. Thus, current understandings from social/behavioral research on how couples in sub-Saharan Africa manage HIV risks as well as HIV prevention interventions to support couples' HIV prevention efforts have remained underdeveloped. It appears that important opportunities are being missed for preventing HIV infection, be it by heterosexual transmission or mother-to-child HIV transmission by mothers who have been infected by their partners. Based on an overview of documentation on VCT in sub-Saharan Africa, this paper proposes that increased attention to couples-focused VCT provides a high-leverage HIV prevention intervention for African countries. The second half of the paper indicates areas where VCT needs to be strengthened, particularly with respect to couples. It also identifies areas where applied social/behavioral research is needed to improve knowledge about how couples in sub-Saharan Africa deal with the risks of HIV infection.Social Science & Medicine 01/2002; 53(11):1397-411. DOI:10.1016/S0277-9536(00)00427-5 · 2.56 Impact Factor