This article by James Wilton first appeared in Prevention in Focus, a publication of CATIE, here.
Une version française est disponible ici.
Serodiscordant couples (where one partner is HIV negative and the other is HIV positive) are often thought to be at “high risk” of HIV transmission. However, new understandings of the biology of HIV transmission and the emergence of new HIV prevention options mean that the HIV transmission risk within these couples can be reduced to very low, even negligible levels.
In fact, preventing HIV transmission may be easier for couples in serodiscordant relationships compared to couples in other types of relationships, such as presumed seroconcordant HIV-negative relationships (where both partners believe themselves to be HIV negative) and individuals in casual relationships.
This article explores this changing HIV risk paradigm and how frontline service providers can help people in known serodiscordant relationships to reduce their HIV transmission risk.
Note: we define a serodiscordant couple as two people (one HIV positive and the other HIV negative) who are in an ongoing sexual relationship in which both partners have tested for HIV and there has been full disclosure of HIV status.
How common are serodiscordant relationships?
We don’t have good estimates of how many people in Canada are in serodiscordant relationships. While HIV-related studies of populations in Canada often ask participants about the HIV status of their sex partners, the full nature of these sexual relationships are rarely explored in detail.
The changing HIV risk paradigm
Serodiscordant couples are often thought to be a population at “high risk” of HIV transmission. Therefore, it may come as a surprise to know that the HIV transmission risk within these couples can be reduced to very low, even negligible levels. This reality is the result of our relatively new knowledge of the biology of HIV transmission and the emergence of new HIV prevention options.
“Contrary to common belief, preventing HIV infection may in fact be easier for couples in serodiscordant relationships compared to couples in other types of relationships . .”
Unfortunately, many people remain fearful of entering into serodiscordant relationships, suggesting this new information on HIV transmission and prevention is not reaching those who need it. For example, in a telephone survey of over 1,000 gay and other men who have sex with men (MSM) across Canada conducted in 2011–2012, 49% of men said they would not have sex with an HIV-positive man even if they were very attracted to him.1 Furthermore, 68% of HIV-positive men in this survey said they worry about being rejected by gay and bisexual men in their community because of their HIV status.
Contrary to common belief, preventing HIV infection may in fact be easier for couples in serodiscordant relationships compared to couples in other types of relationships, such as presumed seroconcordant HIV-negative relationships (where both partners believe they are HIV negative). This is because being in a serodiscordant relationship can:
• Open the option of using antiretroviral treatment (ART) as an HIV prevention strategy. ART can reduce the amount of virus (viral load) in the bodily fluids of an HIV-positive partner to very low levels and this can dramatically reduce a couple’s risk of HIV transmission.
• Provide motivation for the adoption of risk-reduction strategies to prevent HIV transmission. For HIV-negative individuals who are not in a serodiscordant relationship, it can often be difficult to assess one’s risk of HIV transmission. Low perception of HIV risk may reduce motivation to adopt risk-reduction strategies.
• Eliminate uncertainties related to a partner’s HIV status. In seroconcordant HIV-negative relationships, it can be difficult to know for sure whether both partners are actually HIV negative (particularly if the relationship is non-monogamous). If one partner is unknowingly infected with HIV, the couple’s risk of HIV transmission can be very high because the viral load of the HIV-positive partner is probably elevated and the couple may not be using preventative measures.
HIV prevention may also be easier for individuals in stable serodiscordant relationships compared to those who are in more casual relationships. For people who are in stable relationships, there is more opportunity for the ongoing sharing of information that is important for making informed safer sex decisions, such as results of HIV and sexually transmitted infection (STI) screening and viral load testing. Also, partner support can play an important role in ensuring an HIV prevention strategy is used consistently and correctly.
To read the rest of the article go here.