Discordance - Living With the Virus Under One Blanket

[Guest guest]

Uganda: Discordance - Living With the Virus Under One Blanket

ph Matovu

21 December 2008

opinion

Kampala — MARY, 35 and Mike, 45 have been married for 16 years and

have four children. Until recently, they did not know Mike was HIV-

positive. When Mike was tested for HIV at a mobile counselling and

testing centre, he did not believe his results. He said before

marriage, he had never had sex.

" May be it is my wife who infected me. " However, when Mike and his

wife tested together, she turned out to be HIV-negative. This

situation where one partner is infected with HIV and the other one is

not is called HIV discordance.

and Mike are not the only couple in this situation. Many couples

have got married when one of them is infected with HIV, but unaware

of this.

A national HIV/AIDS sero-behavioural survey done by the Ministry of

Health in 2004-2005 found that up to 5% of 4,000 cohabiting couples

were discordant.

Another study in Tororo, eastern Uganda, found that up to 43% of HIV-

infected people had partners who were HIV-negative.

Reacting to the high percentage of HIV discordant couples, Dr

Opio in the Ministry of Health said: " It is strange, but we think it

is partly because there are more people on anti-retroviral therapy,

which gives people a longer life.

It is something we have to address quickly because this friendly fire

infection is very dangerous to our HIV control measures. "

What is worrying is that many of these couples do not know or even

believe that such a situation can exist and continue to live with HIV

under the same blanket unknowingly.

In a recent study by R. Bunnell and colleagues, eight in 10 couples

interviewed did not believe that HIV discordance was possible within

couples, and of these, nine out of every 10 couples did not know the

HIV status of their partners.

One can argue that it is not surprising that couples find it

difficult to understand HIV discordance. Married couples have sex

regularly and since HIV is transmitted through sex, how can one

explain the presence of HIV in one but not the other partner?

Couples have indeed expressed their inability to understand this

situation: " I have failed to understand how this [HIV discordance]

can happen. Up to now I cannot believe that I am HIV-negative when my

partner is HIV-positive, " said one of the HIV-negative partners

interviewed by Bunnell.

This inability to fully understand, let alone, explain HIV

discordance is not restricted to individuals and couples. In a 2005

study, Bunnell found that HIV test counsellors were as confused about

what causes discordance as the explanations provided: " [Discordance]

may mean that she is infected but the body has not yet manufactured

enough antibodies to be detected by the testing machines.

This means that there is a possibility that both of you may be

infected, " explained one of the counsellors interviewed for this

study.

The apparent lack of knowledge about HIV-discordance has affected

efforts to encourage couples to test together.

Studies suggest that only between 10-30% of couples come together for

HIV testing, mainly because of fear for couples to test together for

HIV but also due to beliefs that once one of them is tested, the

other partner's HIV status should automatically be similar to that

for the tested partner.

In the many cases, couples have tested without their partners and

have not disclosed their HIV status to them.

In the event that they disclose, they usually do so to non-sexual

partners first and may take as long as two years or even more before

disclosing to their sexual partners. In this situation of

unawareness, people continue to engage in unprotected sex, resulting

in high levels of transmission of HIV within couples.

These findings suggest a need for increased sensitisation about HIV

discordance and the implications of living in a discordant

relationship unknowingly.

The health education division of the Ministry of Health should come

up with easy-to-understand messages about HIV discordance which

should be disseminated in communities, schools and churches in much

the same way as it was in the 1980s when the epidemic had just struck.

As awareness increases, they will be motivated to test jointly or

disclose their HIV status to their partners. Those who are HIV-

positive can be supported to reduce the risk of transmitting HIV to

their partners.

A recent study by Uganda AIDS Commission suggests that 43% of new

infections occurred among married couples, majority of whom were

living with HIV-infected partners.

In order to fight HIV among married couples, there is need for

increased awareness that HIV discordance is common among married

couples.

It is also important to emphasise that as people continue to live

with HIV infected partners unknowingly, the risk of acquiring HIV is

as high as 10-12% per year.

This means that 10-12% of individuals living with HIV infected

partners will become infected with HIV every year if they don't adopt

any protective measures to guard against HIV.

The writer works with the School of Public Health, Makerere University

[Guest guest]

Uganda: Discordance - Living With the Virus Under One Blanket

ph Matovu

21 December 2008

opinion

Kampala — MARY, 35 and Mike, 45 have been married for 16 years and

have four children. Until recently, they did not know Mike was HIV-

positive. When Mike was tested for HIV at a mobile counselling and

testing centre, he did not believe his results. He said before

marriage, he had never had sex.

" May be it is my wife who infected me. " However, when Mike and his

wife tested together, she turned out to be HIV-negative. This

situation where one partner is infected with HIV and the other one is

not is called HIV discordance.

and Mike are not the only couple in this situation. Many couples

have got married when one of them is infected with HIV, but unaware

of this.

A national HIV/AIDS sero-behavioural survey done by the Ministry of

Health in 2004-2005 found that up to 5% of 4,000 cohabiting couples

were discordant.

Another study in Tororo, eastern Uganda, found that up to 43% of HIV-

infected people had partners who were HIV-negative.

Reacting to the high percentage of HIV discordant couples, Dr

Opio in the Ministry of Health said: " It is strange, but we think it

is partly because there are more people on anti-retroviral therapy,

which gives people a longer life.

It is something we have to address quickly because this friendly fire

infection is very dangerous to our HIV control measures. "

What is worrying is that many of these couples do not know or even

believe that such a situation can exist and continue to live with HIV

under the same blanket unknowingly.

In a recent study by R. Bunnell and colleagues, eight in 10 couples

interviewed did not believe that HIV discordance was possible within

couples, and of these, nine out of every 10 couples did not know the

HIV status of their partners.

One can argue that it is not surprising that couples find it

difficult to understand HIV discordance. Married couples have sex

regularly and since HIV is transmitted through sex, how can one

explain the presence of HIV in one but not the other partner?

Couples have indeed expressed their inability to understand this

situation: " I have failed to understand how this [HIV discordance]

can happen. Up to now I cannot believe that I am HIV-negative when my

partner is HIV-positive, " said one of the HIV-negative partners

interviewed by Bunnell.

This inability to fully understand, let alone, explain HIV

discordance is not restricted to individuals and couples. In a 2005

study, Bunnell found that HIV test counsellors were as confused about

what causes discordance as the explanations provided: " [Discordance]

may mean that she is infected but the body has not yet manufactured

enough antibodies to be detected by the testing machines.

This means that there is a possibility that both of you may be

infected, " explained one of the counsellors interviewed for this

study.

The apparent lack of knowledge about HIV-discordance has affected

efforts to encourage couples to test together.

Studies suggest that only between 10-30% of couples come together for

HIV testing, mainly because of fear for couples to test together for

HIV but also due to beliefs that once one of them is tested, the

other partner's HIV status should automatically be similar to that

for the tested partner.

In the many cases, couples have tested without their partners and

have not disclosed their HIV status to them.

In the event that they disclose, they usually do so to non-sexual

partners first and may take as long as two years or even more before

disclosing to their sexual partners. In this situation of

unawareness, people continue to engage in unprotected sex, resulting

in high levels of transmission of HIV within couples.

These findings suggest a need for increased sensitisation about HIV

discordance and the implications of living in a discordant

relationship unknowingly.

The health education division of the Ministry of Health should come

up with easy-to-understand messages about HIV discordance which

should be disseminated in communities, schools and churches in much

the same way as it was in the 1980s when the epidemic had just struck.

As awareness increases, they will be motivated to test jointly or

disclose their HIV status to their partners. Those who are HIV-

positive can be supported to reduce the risk of transmitting HIV to

their partners.

A recent study by Uganda AIDS Commission suggests that 43% of new

infections occurred among married couples, majority of whom were

living with HIV-infected partners.

In order to fight HIV among married couples, there is need for

increased awareness that HIV discordance is common among married

couples.

It is also important to emphasise that as people continue to live

with HIV infected partners unknowingly, the risk of acquiring HIV is

as high as 10-12% per year.

This means that 10-12% of individuals living with HIV infected

partners will become infected with HIV every year if they don't adopt

any protective measures to guard against HIV.

The writer works with the School of Public Health, Makerere University