Living with discordance: knowledge, challenges, and prevention strategies of HIV-discordant couples in Uganda

Prevalence of HIV-discordance among couples in sub-Saharan Africa is high. Negative partners are at high risk of HIV infection but few HIV/AIDS service providers have developed effective counseling messages for HIV-discordant couples. To identify clients' explanations for discordance, challenge...

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Bibliographic Details
Published in:	AIDS care Vol. 17; no. 8; pp. 999 - 1012
Main Authors:	Bunnell, R. E., Nassozi, J., Marum, E., Mubangizi, J., Malamba, S., Dillon, B., Kalule, J., Bahizi, J., Musoke, N., Mermin, J. H.
Format:	Journal Article
Language:	English
Published:	Abingdon Taylor & Francis Group 01-11-2005 Taylor & Francis Taylor & Francis Ltd
Subjects:	Acquired Immune Deficiency Syndrome Adult Africa AIDS AIDS/HIV Biological and medical sciences Counseling Counseling - standards Counselling Couples Disease transmission Diseases Female Focus Groups Health care Health education Health Knowledge, Attitudes, Practice HIV HIV Infections - prevention & control HIV Infections - psychology HIV Infections - transmission HIV Seronegativity HIV Seropositivity - immunology HIV Seropositivity - psychology HIV-discordant couples Human immunodeficiency virus Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Intervention Knowledge Male Male-female relationships Medical sciences Middle Aged Myth Perceptions Prevention Risk assessment Risk management Safe sexual practices Sexual Behavior - psychology Sexual intercourse Sexual Partners - psychology Sexually transmitted diseases Sub Saharan Africa Surveys and Questionnaires Time Factors Uganda VCT Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Uganda Africa Human Immunopathology Couple Retroviridae AIDS Immune deficiency Lentivirus Infection Virus Prevention Viral disease Strategy Human immunodeficiency virus Public health
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Summary:	Prevalence of HIV-discordance among couples in sub-Saharan Africa is high. Negative partners are at high risk of HIV infection but few HIV/AIDS service providers have developed effective counseling messages for HIV-discordant couples. To identify clients' explanations for discordance, challenges, and prevention strategies, 24 in-depth interviews and 4 focus group discussions were conducted with 32 female and 35 male members of HIV-discordant couples who sought HIV voluntary counseling and testing (VCT) in Uganda. In addition, counselor explanations for discordance were gathered from 62 counselor trainers during 3 interactive workshops. Misconceptions about discordance were widespread among clients and counselors. Common explanations included: the concept of a hidden infection not detectable by HIV tests, belief in immunity, the thought that gentle sex protected HIV-negative partners, and belief in protection by God. Such explanations for discordance reinforced denial of HIV risk for the negative partner within discordant couples and potentially increased transmission risk. Couples identified negotiation of sexual relations as their most formidable challenge. Prevention strategies included condom use, abstinence and separation of beds, contractual agreements for outside sexual partners, and relationship cessation. Discordant couples represent a critical risk group and improved counseling protocols that clearly explain discordance, emphasize high risk of transmission, and support risk reduction are urgently needed.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0954-0121 1360-0451
DOI:	10.1080/09540120500100718