The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda

Gray, Ron; Ssempiija, Victor; Shelton, James D; Serwadda, David; Nalugoda, Fred; Kagaayi, Joseph; Kigozi, Godfrey; Wawer, Maria J.

doi:10.1097/qad.0b013e3283448790

Cited by 36 publications

(29 citation statements)

References 11 publications

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“…This observation is not surprising, as partners only remain at risk for HIV acquisition from outside partners, a substantial driver of new infections in the region. 32,33 Understanding which HIV-uninfected women are at highest risk for HIV acquisition is critical as HIV incidence among pregnant women is high and may account for a substantial share of new pediatric HIV cases. 34,35 Understanding which HIV-uninfected women are at highest risk for HIV acquisition is the focus of a future analysis.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study

Rosenberg

Graybill

Wesevich

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background In sub-Saharan Africa couple HIV testing and counseling (CHTC) has been associated with substantial increases in safe sex, especially when at least one partner is HIV-infected. However, this relationship has not been characterized in an Option B+ context. Setting The study was conducted at the antenatal clinic at Bwaila District Hospital in Lilongwe, Malawi in 2016 under an Option B+ program. Methods Ninety heterosexual couples with an HIV-infected pregnant woman (female-positive couples) and 47 couples with an HIV-uninfected pregnant woman (female-negative couples) were enrolled in an observational study. Each couple member was assessed immediately before and one month after CHTC for safe sex (abstinence or consistent condom use in the last month). Generalized estimating equations were used to model change in safe sex before and after CHTC and to compare safe sex between female-positive and female-negative couples. Results Mean age was 26 years among women and 32 years among men. Before CHTC, safe sex was comparable among female-positive couples (8%) and female-negative couples (2%) (RR: 3.7, 95% CI: 0.5, 29.8). One month after CHTC, safe sex was higher among female-positive couples (75%) than among female-negative couples (3%) (RR: 30.0, 95% CI: 4.3, 207.7). Safe sex increased substantially after CTHC for female-positive couples (RR 9.6, 95% CI: 4.6, 20.0), but not for female-negative couples (RR: 1.2, 95% CI: 0.1, 18.7). Conclusion Engaging pregnant couples in CHTC can have prevention benefits for couples with an HIV-infected pregnant woman, but additional prevention approaches may be needed for couples with an HIV-uninfected pregnant woman.

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Section: Discussionmentioning

confidence: 99%

The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study

Rosenberg

Graybill

Wesevich

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…In many societies, multiple sexual partners are condoned for men, while women are expected to remain faithful [14, 15], and unprotected sex with extramarital partners is a risk factor for HIV infection [16-22]. Wide age disparities between spouses (e.g >10 years age difference) could contribute to risk if younger women marry older men who are more likely to be infected, and age disparities could reduce a woman's ability to negotiate safer sex behaviors such as condom use increasing risk of HIV infection [23-25].…”

Section: Discussionmentioning

confidence: 99%

Marriage and the Risk of Incident HIV Infection in Rakai, Uganda

Nalugoda

Guwatudde

Bwaninka

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Studies suggest that the prevalence of HIV is higher among long term marital/consensual relationships than in the unmarried. We assessed the risk of incident HIV infection by marital status in rural Rakai, Uganda. Design Longitudinal data from the Rakai Community Cohort Study (RCCS) between 1999 - 2011 Methods We estimated HIV incidence per 100 person years (py) in sexually active individuals aged 15-49 with a total of 44,179.6 person years (py) who were never married (females 2,929py, males 4,261py), currently married or in long-term consensual relationships (“currently married females 29,823py, males 21,299py) and previously married (females 3,563py, males 1,475). Poisson multivariable regression was used to estimate the unadjusted and adjusted incident rate ratios (IRRs) and 95% confidence intervals (95% CI) of HIV acquisition. Results HIV incidence among currently married persons was 0.93/100py, which was lower than the never married (1.51/100py) and previously married (2.85/100py). The risk of HIV acquisition was significantly lower in the currently married compared to the never married among women (Adj IRR=0.26, 95% CI: 0.16-0.42), but not men (Adj IRR=0.69, 95% CI: 0.31-1.52). HIV incidence was lower among first marriages (0.73/100py) compared to second or higher order marriages (1.38/100py). Multiple sex partners significantly increased the risk of HIV acquisition in both women (Adj IRR=2.53, 95% CI: 1.6, 3.97) and men (Adj IRR=1.77, 95% CI: 1.20-2.60). Conclusion Current marriage especially first order marriage was associated with reduced risk of HIV acquisition in women, but not in men, and multiple sex partnerships increased HIV risk for both sexes.

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“…In Rakai, the risk of HIV acquisition per person was 0.5% (95% CI 0.3% to 0.8%) in round I prior to antiretroviral therapy availability among persons in concordant negative couples, versus 0.7% (95% CI 0.4% to 1.0%) among unmarried persons (over about 14 months of follow-up). These estimates were calculated from the data in Gray et al 5 In round II post antiretroviral therapy availability, it was 0.7% (95% CI 0.5% to 0.9%) versus 1.1% (95% CI 0.8% to 1.4%) (over about 18 months of follow-up). These values suggest that the risk of external infection among persons in stable couples is comparable, though possibly somewhat lower, than those among unmarried persons.…”

Section: Discussionmentioning

confidence: 99%

“…This issue has recently received much attention in light of the debate about the contribution of HIV sero-conversions among SDCs to the HIV epidemic in sub-Saharan Africa (SSA). [3][4][5] Against this background, we constructed a mathematical model parameterised by state of the art empirical data to calculate the population-level fraction of new HIV-1 infections among SDCs that are due to sources external to the couple in 20 countries in SSA.…”

Section: Introductionmentioning

confidence: 99%

External infections contribute minimally to HIV incidence among HIV sero-discordant couples in sub-Saharan Africa

Chemaitelly

Abu‐Raddad

2012

Sex Transm Infect

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ObjectiveRecent randomised clinical trials among stable HIV sero-discordant couples (SDCs) in sub-Saharan Africa (SSA) have reported that about 20–30% of new HIV infections are acquired from external sexual partners, rather than transmitted from the infected to the uninfected partner within the couple. The aim of this study is to examine whether, and to what extent, these findings are generalisable to SDCs in the wider population in SSA.MethodsA mathematical model was constructed to calculate the fraction of new HIV-1 infections among SDCs that are due to sources external to the couple. The model was parameterised using empirical and population-based data for 20 countries in SSA. Uncertainty and sensitivity analyses were also conducted.ResultsThe contribution of external infections among SDCs was generally modest, but it varied widely across SSA. In low HIV prevalence countries (≤3.0%), it ranged from 0.6–2.9%. In intermediate prevalence countries (3.0–18.0%), it ranged from 4.9–11.7%. In Swaziland and Lesotho, the world's most-intense epidemics, sizable levels of 27.9% and 27.3% were found, respectively.ConclusionsIn most countries in SSA, nearly all HIV acquisitions by the uninfected partners in SDCs appear to be due to transmissions from the HIV infected partners in the SDCs. The contribution of externally acquired infections varies with HIV population prevalence, but rarely exceeds 10% in the majority of countries. Only in hyperendemic HIV epidemics the contribution of external infections is substantial and may reach the levels reported in recent randomised clinical trials involving SDCs.

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The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda

Cited by 36 publications

References 11 publications

The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study

The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study

Marriage and the Risk of Incident HIV Infection in Rakai, Uganda

External infections contribute minimally to HIV incidence among HIV sero-discordant couples in sub-Saharan Africa

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