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HIV Testing and Counseling Leads to Immediate Consistent Condom Use among South African Stable HIV-Discordant Couples

Citation

Rosenberg, Nora E.; Pettifor, Audrey E.; De Bruyn, Guy; Westreich, Daniel J.; Delany-Moretlwe, Sinead; Behets, Frieda M.-T. F.; Maman, Suzanne; Coetzee, David; Kamupira, Mercy; & Miller, William C. (2013). HIV Testing and Counseling Leads to Immediate Consistent Condom Use among South African Stable HIV-Discordant Couples. Journal of Acquired Immune Deficiency Syndromes, 62(2), 226-233. PMCID: PMC3548982

Abstract

INTRODUCTION: Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling (HTC) with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples.
METHODS: Partners in Prevention HSV/HIV Transmission Study was a randomized trial conducted from 2004-2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1 co-infected persons to HIV-uninfected sex partners. This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants. The exposure was timing of first HTC: 0-7, 8-14, 15-30, or >30 days before baseline. In each exposure group, predicted probabilities of unprotected sex in the last month were calculated at baseline, month one, and month twelve using generalized estimating equations with a logit link and exchangeable correlation matrix.
RESULTS: At baseline, participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month: 0-7 days, 0.71; 8-14 days, 0.52; 15-30 days, 0.49; >30 days, 0.26. At month one, once all participants had been aware of being in HIV-discordant relationships for >/=1 month, predicted probabilities declined: 0-7 days, 0.08; 8-14 days, 0.08; 15-30 days, 0.15; >30 days, 0.14. Lower predicted probabilities were sustained through month twelve: 0-7 days, 0.08; 8-14 days, 0.11; 15-30 days, 0.05; >30 days, 0.19.
CONCLUSIONS: Unprotected sex declined after HIV-positive diagnosis, and declined further after awareness of HIV-discordance. Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk.

URL

http://dx.doi.org/10.1097/QAI.0b013e31827971ca

Reference Type

Journal Article

Year Published

2013

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

Rosenberg, Nora E.
Pettifor, Audrey E.
De Bruyn, Guy
Westreich, Daniel J.
Delany-Moretlwe, Sinead
Behets, Frieda M.-T. F.
Maman, Suzanne
Coetzee, David
Kamupira, Mercy
Miller, William C.

PMCID

PMC3548982