HIV seroconcordance among heterosexual couples in rural KwaZulu‐Natal, South Africa: a population‐based analysis

Abstract

Introduction High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub‐Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa. Methods We followed adults (≥15 years old) using a population‐based, longitudinal and open surveillance system in KwaZulu‐Natal, South Africa, from 2003 to 2016. Sexual partnerships and HIV status were confirmed via household surveys and annual HIV surveillance. We calculated the proportions of HIV seroconcordance and serodiscordance in stable sexual partnerships and compared them to the expected proportions under the assumption of random mixing using individual‐based microsimulation models. Among unpartnered individuals, we estimated the incidence rates and hazard of sexual partnership formation with HIV‐positive or HIV‐negative partners by participants' own time‐varying HIV status. Competing risks survival regressions were fitted adjusting for sociodemographic and clinical factors. We also calculated Newman's assortativity coefficients. Results A total of 18,341 HIV‐negative and 11,361 HIV‐positive individuals contributed 154,469 person‐years (PY) of follow‐up. Overall, 28% of the participants were in stable sexual partnerships. Of the 677 newly formed stable sexual partnerships, 7.7% (95% CI: 5.8 to 10.0) were HIV‐positive seroconcordant (i.e. both individuals in the partnership were HIV‐positive), which was three times higher than the expected proportion (2.3%) in microsimulation models based on random mixing. The incidence rates of sexual partnership formation were 0.54/1000PY with HIV‐positive, 1.12/1000PY with HIV‐negative and 2.65/1000PY with unknown serostatus partners. HIV‐positive individuals had 2.39 (95% CI: 1.43 to 3.99) times higher hazard of forming a sexual partnership with an HIV‐positive partner than did HIV‐negative individuals after adjusting for age, opposite‐sex HIV prevalence (by 5‐years age groups), HIV prevalence in the surrounding community, ART coverage and other sociodemographic factors. Similarly, forming a sexual partnership with an HIV‐negative partner was 1.47 (95% CI: 1.01 to 2.14) times higher in HIV‐negative individuals in the adjusted model. Newman's coefficient also showed that assortativity by participant and partner HIV status was moderate (r = 0.35). Conclusions A high degree of population level HIV seroconcordance (both positive and negative) was observed at the time of forming new sexual partnerships. Understanding factors driving these patterns may help the development of strategies to bring the HIV epidemic under control.

Barriers, Facilitators, and Strategies to Improve Participation of a Couple-Based Intervention to Address Women’s Antiretroviral Therapy Adherence in KwaZulu-Natal, South Africa

“…A few potential barriers emerged around the role of men with HIV-how their adherence needs would be addressed in the intervention, lack of men's disclosure prior to the intervention, or an unexpected HIV status disclosure and potential relationship fallout during the CBI. Data on the HIV concordance rate for couples in KwaZulu-Natal suggest that approximately one-third of people living with HIV enter into a relationship with a partner who is known to be living with HIV [13]. Given this, it is likely that some couples will present to this intervention where the male partner is also living with HIV and potentially struggling with adherence.…”

“…There are several reasons to believe that a CBI would be appropriate for addressing women's ART adherence in South Africa. First, many women with HIV are partnered or enter into new relationships after relationship dissolution [13], so working with women and their partners is realistic. Second, most women are in heterosexual relationships, in which men hold much power in the relationship, including over healthcare behaviors and decisions [14].…”

Optimising a couples-focused intervention to increase couples’ HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa

“…In a large community-based survey of adults in KZN, 19% of men and 41% of women were living with HIV in 2017. 5 The majority of couples in stable sexual relationships reported being unaware of their partner’s HIV status (57%), 6 and testing rates remain low, particularly for men. 7 CHTC can contribute to reductions in HIV incidence as a compliment to the universal test and treat policy in South Africa 8 and individual focused testing campaigns.…”

Sexually Transmitted Infection Prevalence, Partner Notification, and Human Immunodeficiency Virus Risk Perception in a Cohort of Women Completing Sexually Transmitted Infection Screening as Part of a Safer Conception Study

“…1 Ten percent to 15% are in HIV-serodifferent relationships. 2,3 For individuals whose partners have HIV, periconception and pregnancy are associated with HIV acquisition risks. 4 Women engaging in condomless sex may acquire curable sexually transmitted infections (STIs), which can confer morbidities to the woman and her future infant, 5,6 and increase chances of acquiring HIV.…”

“…Over 7 million people with human immunodeficiency virus (HIV) (PWH) live in South Africa 1 . Ten percent to 15% are in HIV-serodifferent relationships 2,3 . For individuals whose partners have HIV, periconception and pregnancy are associated with HIV acquisition risks 4 .…”