Poor knowledge of partner HIV status among South African women with recent pregnancy

Over 40% of women with recent pregnancy and a third of men with recent partner pregnancy do not know the HIV infection status of their partner, research conducted in Durban, South Africa, published in BMC Public Health shows. Moreover, only 4% of women and 13% of men knew they were in a serodiscordant relationship (one partner living with HIV, the other HIV negative) prior to pregnancy.

“HIV prevalence for adults aged 15-49 years in KwaZulu-Natal is estimated at 28% and the prevalence of serodiscordant couples is likely to be between 20 and 30%,” note the authors. “Our data are unlikely to reflect low prevalence of serodiscordant couples, rather they indicate the low prevalence of HIV serostatus disclosure and/or knowledge of personal HIV status.”

More needs to be done to increase testing and disclosure within relationships, say the authors. Otherwise, the low level of partner HIV status revealed by the study could mean that the use of antiretroviral therapy (ART) as prevention and pre-exposure prophylaxis (PrEP) are likely to have little impact in South Africa.

Glossary

serodiscordant

A serodiscordant couple is one in which one partner has HIV and the other has not. Many people dislike this word as it implies disagreement or conflict. Alternative terms include mixed status, magnetic or serodifferent.

disclosure

In HIV, refers to the act of telling another person that you have HIV. Many people find this term stigmatising as it suggests information which is normally kept secret. The terms ‘telling’ or ‘sharing’ are more neutral.

serostatus

The presence or absence of detectable antibodies against an infectious agent, such as HIV, in the blood. Often used as a synonym for HIV status: seronegative or seropositive.

antenatal

The period of time from conception up to birth.

harm reduction

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (including safer use, managed use and abstinence). It is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

Serodiscordant couples who wish to have children are recommended to take early ART and to have timed peri-ovulatory intercourse. These steps substantially reduce the risk of HIV transmission during intercourse. But to benefit from these interventions, individuals need to be aware of their own HIV status and that of their partner.

Investigators wanted to know what proportion of women with recent pregnancy (within the previous twelve months) and men with recent partner pregnancy (within the previous 36 months) who were in serodiscordant relationships were aware they were in a relationship with a partner of a different HIV infection status at the time of conception.

Women aged between 18 and 45 years were recruited via an antenatal clinic and men aged 18 and over from an ART clinic.

Of the 2344 eligible women, 41% did not know the HIV status of their partner at the time of conception and only 92 (4%) knew they were in a serodiscordant relationship before their pregnancy.

A total of 225 men were recruited to the study and almost a third (32%) did not know their partner’s HIV status at pregnancy screening, with only 30 (13%) reporting knowing they were in a serodiscordant relationship before their partner conceived.

Moreover, 29% of men living with HIV and 47% of women living with HIV who had an HIV-negative partner were unaware of their own HIV status before conception.

“A large proportion of women (41%) and men (32%) did not know their recent pregnancy partner’s HIV serostatus,” conclude the investigators. “Safer conception and general HIV prevention strategies for HIV-serodiscordant couples require solutions to increase testing and mutual disclosure between sexual partners. In addition, a harm-reduction approach to reducing periconception transmission should address couples as well as individuals who cannot engage their partners.”

References

Matthews LT et al. South Africans with recent pregnancy rarely know partner’s HIV serostatus: implications for serodiscordant couples’ interventions. BMC Public Health, 14:843, 2014.  doi:10.1186/1471-2458-14-843