A sero-discordant couple-also referred to as a couple of mixed-status- is a relationship where one partner is infected by HIV and the other is not. A sero-discordant couple can also be used to describe a relationship where one person’s blood tests positive for HIV and the other does not. There are high risks and rates of HIV acquisition and transmission in serodiscordant relationships. Studies in sub-saharan Africa have found that women living with HIV positive partners were 37.9% to 105.8% times more likely to seroconvert than those living in concordant-negative partnerships. A 2013 modeling study among 20 countries in sub-saharan Africa estimated that 29% of new infections occurred within stable serodiscordant couples. Among MSMs, an estimated 33-67% of new HIV infections occur within a primary relationship.
Preventing HIV transmission within sero-discordant couples involves the utilization of various methods. These include:
Behavioral Approach: This includes couples HIV Testing and Counseling (HTC). Couples HIV Testing and Counseling (CHTC) increases testing, condom use, and decreases seroconversion. Behavioral approach also embodies Couple-Based Interventions which are designed specifically for couples. These programs promote established risk-reduction behaviors (e.g condom use, decreasing the number of sexual partners etc) as well as couple-relevant strategies including communication and negotiation skills.
Biomedical Approach: This encompasses the use of medical treatments to reduce the transmission of HIV. Biomedical approaches include ARVs for prevention or post-exposure prophylaxis, barrier methods such as male and female condoms, procedures such as medical male circumcision or other methods to eliminate risk of HIV transmission. Biomedical approaches also encompasses testing and treatment for sexually transmitted infections, which are common among people living with HIV and amplify transmission. Thus, it is vital that partners within serodiscordant relationships should be regularly tested as STI may increase both transmission and acquisition vulnerability for HIV.
Treatment as prevention (TasP) refers to HIV prevention methods and programmes that use antiretroviral treatment (ART) to decrease the risk of HIV transmission. When adhered to consistently, ART can reduce the HIV viral load in an individual’s blood, semen, vaginal fluid and rectal fluid to such a low level that blood tests can’t detect it. Thus Undetectable=Untransmittable. An HIV-positive partner can protect himself and his partner by unflinchingly adhering to his medication. An HIV-positive partner with an undetectable viral load is extremely unlikely to transmit HIV through sexual contact. However, safe sex practices still need to be effected.
Pre-exposure Prophylaxis (PrEP) is a form of HIV prevention that uses anti-HIV drugs to protect HIV-negative people from acquiring HIV. With PrEP, the uninfected partner is treated with an HIV drug, which reduces his chances of contracting the virus. However, PrEP is neither perfect, nor does it protect against other sexually transmitted infections. Thus, both partners should use condoms while engaging in sexual intercourse.
If a woman who has HIV gets pregnant, there are recommendations for reducing the risk that her infant will be born HIV positive. The most important is to have adequate prenatal care and appropriate treatment for HIV. In addition, the infant may need to be treated after birth. For women whose HIV is not fully suppressed, a cesarean section might be scheduled before the membranes rupture. This has the potential to reduce the risk that the baby will be exposed to HIV during delivery. Also, When the female partner is the one who is HIV positive, she can be inseminated with her partner’s sperm using artificial insemination, in vitro-fertilization, or intrauterine insemination. With these methods, partners don’t need to have unprotected sex to conceive. If the male partner is the one who is HIV positive, options include using a sperm donor and/or washing sperm. Men can also make certain that their viral load is suppressed as fully as possible before having unprotected sex in an attempt to conceive.
In summary, HIV is not a death sentence, health-wise and relationship-wise. With proper precautions and the right dispositions, couples can live the best life possible!!!