Offering married couples in sub-Saharan Africa joint HIV counseling and testing could curb the spread of sexually transmitted HIV in those regions by up to 60 percent, a new study finds.
The paper, published in the June 28, 2008 issue of the journal Lancet, notes that joint Voluntary Counseling and Testing (VCT) of couples in urban Rwanda and Zambia could be as effective at HIV prevention for both women and men as circumcision is for men.
"Marriage is increasingly recognized as a potentially high-risk setting for heterosexual HIV transmission, especially for women, but this is the first attempt we are aware of to estimate the total burden of HIV attributable to marital transmission," says study author Kristin Dunkle, PhD, MPH, an assistant professor of behavioral science and health education at Emory University's Rollins School of Public Health.
Dunkle and a team of Emory public health and African-based researchers used population-based Demographic and Health Survey data on sexual behavior. They also used data from Emory's Rwanda Zambia HIV Research Group on the joint HIV status of married or cohabiting couples and non-cohabiting couples in Lusaka, Zambia, and Kigali, Rwanda.
Researchers estimated the probability that an individual would acquire HIV infection from a marital/cohabiting partner or a non-cohabiting partner, and then the proportion of total heterosexual HIV transmission that likely occurs within married or cohabiting couples in these settings each year.
The study found that 55 percent to 93 percent of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda take place within marriage and cohabitation. Providing Voluntary Counseling and Testing to these couples could avert 36 percent to 60 percent of HIV infections that would otherwise occur.
"Traditional approaches to HIV prevention such as promoting abstinence and fidelity are clearly inadequate and inappropriate," Dunkle says. "Marriage can and does place both women and men at high risk for HIV infection, and we need prevention strategies that directly address that reality."
Dunkle and team call for increased promotion of couples-based voluntary counseling and testing as well as development of other evidence-based, culturally and gender-sensitive interventions targeting heterosexual couples.
Study authors were Kristin Dunkle, PhD, Rob Stephenson, PhD, Lauren Greenberg, MPH, and Susan Allen, MD, all from the Rollins School of Public Health, Emory University; Etienne Karita, MD and Kayitesi Kayitenkore, MD, both from Project San Francisco, Rwanda Zambia HIV Research Group in Kigali, Rwanda; and Elwyn Chomba, MD and Cheswa Vwalika, MD, both from the Zambia-Emory HIV Research project, Rwanda Zambia HIV Research Group in Lusaka, Zambia.
This study has been funded primarily by federal funds from the US National Institute of Mental Health Grant R01 MH 66767, with contributions from National Institute of Child Health and Human Development, National Institute of Allergy and Infectious Diseases (NIH grants R01 HD 40125, R01 AI40951, AI51231), the Fogarty AIDS International Training and Research Program FIC 2D43 TW001042, the Social & Behavioral Core of the Emory Center for AIDS Research P30 AI050409, and the International AIDS Vaccine Initiative.
Reference: Lancet, June 28, 2008