Altered states: When one partner is HIV positive

In a new study, Laetitia Rispelanalyses the needs of HIV-discordant couples, were one partner is HIV positive and the other HIV negative, and concludes that policy and research pay insufficient attention to such couples.

The researchers conducted an exploratory study to assess sexual health, reproductive desires, strategies for preventing HIV transmission to the negative partner, and sexual and reproductive health-service needs of HIV-discordant couples in long-term relationships. The research was commissioned by an advocacy organisation, Global Network of People Living with HIV (GNP+). It focused on discordant couples because many HIV infections occur between couples in established relationships, particularly in sub-Saharan Africa, and their needs were inadequately addressed in intervention programmes.

Findings in three countries

The study was conducted in South Africa and Tanzania, where HIV is transmitted mostly through heterosexual intercourse, and the Ukraine, where HIV is transmitted largely through injection drug use. The researchers recruited 51 couples, with one partner HIV positive and the other HIV negative, and who had been in a relationship for at least one year. They were recruited through healthcare providers and civil society organisations in South Africa (26 couples), Tanzania (10), and the Ukraine (15).

Brief self-administered questionnaires and in-depth semi-structured individual and couple interviews were used to study health and wellness management, strategies for reducing the risk of transmitting HIV to the negative partner, parental status and reproductive intentions, and treatment, care and support needs.

The study found that just over half (51%) of the couples and almost half (47%) of the HIV-positive individuals in the study desired a child or children. Among individuals, almost three-quarters (74%) of those without children desired children, while just over one-third (36%) with children desired additional children. Three out of every five participants (61%) reported that intimacy had been affected by their discordant relationship, with changes in sexual relations due to the need for condom use as well as fears of infecting the negative partner, which often conflicted with the desire for children.

In South Africa and Tanzania combined, 43% of the HIV-positive participants reported having experienced some form of discrimination compared to 24% of the HIV-negative participants, with discrimination reported more frequently by the Tanzanian participants. Several Ukrainian participants reported discrimination from healthcare professionals.

Participants reported a shortage of information, educational materials and support services for discordant couples, with less than half (45%) participating in support groups in the past year.

Just over half (51%) of the couples and almost half (47%) of the HIV-positive individuals in the study desired a child or children  
What could be done?

The researchers recommended that recognising HIV discordance and addressing the needs of discordant couples should form an integral part of global and national responses to the HIV epidemic. The greater involvement of people living with HIV, a widely recognised key principle in the HIV response, should include involving discordant couples. Epidemiological information on discordant couples should be collected as part of routine HIV surveillance. Further research should focus on their reproductive, information and social-service needs.

The high proportion of HIV-positive individuals and discordant couples desiring children revealed a need for explicit HIV policies recognising the reproductive rights of people living with HIV, and respect for their choice to have children. Reported experiences revealed a need for interventions to address stigma and discrimination, and to educate and orientate healthcare professionals in this regard.

Policies and programmes should promote the health of both partners and address the challenges of discordant partnerships, as well as provide advice on: health education, information on healthy living, preventing HIV transmission, couples counselling, testing services and support groups.

Professor Laetitia Rispel is the former executive director of the Social Aspects of HIV/AIDS and Health at the HSRC and is now at the Centre for Health Policy at the University of the Witwatersrand.