Most HIV transmission for men and women in Africa is within marriage or cohabitation

June 26, 2008

Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples. These are the conclusions of authors of an Article in this week's edition of The Lancet.

Sub-Saharan Africa has a well-documented and high rate of HIV infection, most of which is attributable to heterosexual transmission. Few attempts have been made to assess the extent of HIV transmission within marriages, and HIV-prevention efforts remain focused on abstinence and non-marital sex.

Dr Kristin Dunkle, Rollins School of Public Health, Emory University, Atlanta, GA, USA, and colleagues across Zambia and Rwanda, used population data from Demographic Health Surveys on heterosexual behaviour in Zambia 2001/02 and Rwanda in 2005. They also used data on the HIV joint status of married or cohabiting couples and non-cohabiting couples in Lusaka, Zambia, and Kigali, Rwanda. They estimated the probability that an individual would acquire an incident HIV infection from a cohabiting or non-cohabiting partner, and then the proportion of total heterosexual HIV transmission which likely occurs within married or cohabiting couples in these settings each year.

The researchers analysed data from 1739 Zambian women, 540 Zambian men, 1176 Rwandan women, and 606 Rwandan men. Using modelling they estimated that 55-93% of new heterosexually acquired HIV infections among adults in urban Zambia and Rwanda probably occur within marital or cohabiting couples, with slight variations between women and men and between Zambia and Rwanda. When they extended their model to include higher rates of condom use reported in non-cohabiting partners, the estimate of new heterosexually acquired HIV infections occurring within marital or cohabiting couples went up to 60-94%. HIV transmission in non blood-related couples who are both unaware of their HIV status is estimated to be 20% each year. The researchers estimated than an intervention for couples which reduced this transmission in cohabiting couples from 20% to 7% each year, as observed in couples counselling studies in Zambia, could avert between 36-60% of heterosexually transmitted HIV infections that would otherwise occur.

The authors conclude: "Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counselling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples."

In an accompanying Comment, Dr Rebecca Bunnell, Global AIDS Program, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya and Dr Peter Cherutich, National AIDS/STD Control Programme, Ministry of Health, Nairobi, Kenya, say: "The findings by Dunkle and colleagues are an urgent call to governments and programmes for HIV prevention, care, and treatment throughout the continent to truly scale up HIV testing with an emphasis on couples and a goal of universal coverage. Definition, standardisation, and implementation of a complete package for efficacious couple-based interventions for all types of couples for HIV prevention and care, including antiretroviral therapy and circumcision, will further decrease HIV transmission within the largest population group at risk within sub-Saharan Africa."
-end-
Dr Kristin Dunkle, Rollins School of Public Health, Emory University, Atlanta, GA, USA currently in South Africa T) +27 82 721 8345 E) kdunkle@sph.emory.edu

Dr Rebecca Bunnell, Global AIDS Program, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya T) +254-724-256-809 E) rrb7@cdc.gov

http://multimedia.thelancet.com/pdf/press/HIV.pdf

Lancet

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.