Submitted by: Bureau for Global Health

Do discordant couples, or those in which only one partner is HIV-positive, really contribute a majority of new HIV infections?  Should interventions to address discordant couples receive a majority of funding? As the global response to HIV and AIDS evolves, fostering an open dialogue about what approaches work best is essential to mounting an effective response to the global pandemic. To achieve this, the Office of HIV/AIDS at USAID and the World Bank’s Global HIV/AIDS Program are co-sponsoring a debate series to examine emerging and sometimes controversial issues in HIV prevention. The latest debate, held August 26, at the World Bank headquarters in D.C. with webcast participants from over 20 countries, examined the role of HIV counseling and testing among couples in which only one of the two partners has HIV.

Drs. Susan Allen and Elizabeth Marum presented several sets of data to support the proposition. According to Dr. Allen’s work in Rwanda and Zambia, a majority of new infections were the result of transmission within co-habiting or married couples. Drs. Allen and Marum additionally argued that couples testing and counseling was an evidence-based and cost-effective intervention, which should be scaled up to prevent large numbers of new infections.

On the contrary, Drs. Gray and Halperin provided data opposing the proposition. For instance, in Rakai, Uganda, intra couple transmission within known HIV discordant couples contributed approximately 30 percent of new infections.  Among other arguments, Dr. Halperin stated that a majority of new infections cannot logically emerge from long-term stable couples in countries where marriage and cohabitation rates are low.  Drs. Gray and Halperin concluded that a majority of new infections emerge from multiple and concurrent partnering practices and therefore that a majority of prevention funding should not be utilized for addressing sero-discordance among long-term stable partnerships.

These and other points of views made for a lively discussion that will hopefully improve our understanding about what drives HIV epidemics in Southern Africa.

Save the date of October 18, 2010, for the fourth debate in this series that will examine concurrent sexual partnerships.

Visit the Office of HIV/AIDS AIDSTAR-One HIV Prevention Knowledge Base to access resources about HIV Prevention for Serodiscordant Couples drawing on epidemiologic and demographic data.