title: Sexual behavior of HIV discordant couples after HIV counseling and testing.
abstract: OBJECTIVE
  Sexual behavior following voluntary HIV counseling and testing (VCT) is described in 963 cohabiting heterosexual couples with one HIV positive and one HIV negative partner ('discordant couples'). Biological markers were used to assess the validity of self-report.
  
  
  METHODS
  Couples were recruited from a same-day VCT center in Lusaka, Zambia. Sexual exposures with and without condoms were recorded at 3-monthly intervals. Sperm detected on vaginal smears, pregnancy, and sexually transmitted diseases (STD) including HIV, gonorrhea, syphilis, and Trichomonas vaginalis were assessed.
  
  
  RESULTS
  Less than 3% of couples reported current condom use prior to VCT. In the year after VCT, > 80% of reported acts of intercourse in discordant couples included condom use. Reporting 100% condom use was associated with 39-70% reductions in biological markers; however most intervals with reported unprotected sex were negative for all biological markers. Under-reporting was common: 50% of sperm and 32% of pregnancies and HIV transmissions were detected when couples had reported always using condoms. Positive laboratory tests for STD and reported extramarital sex were relatively infrequent. DNA sequencing confirmed that 87% of new HIV infections were acquired from the spouse.
  
  
  CONCLUSIONS
  Joint VCT prompted sustained but imperfect condom use in HIV discordant couples. Biological markers were insensitive but provided evidence for a significant under-reporting of unprotected sex. Strategies that encourage truthful reporting of sexual behavior and sensitive biological markers of exposure are urgently needed. The impact of prevention programs should be assessed with both behavioral and biological measures.
authors.affiliation: Department of Epidemiology and International Health, School of Public Health, University of Alabama in Birmingham, 35294, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
authors.forename: Jareen
authors.initials: J
authors.lastname: Meinzen-Derr
authors.forename: Michele
authors.initials: M
authors.lastname: Kautzman
authors.forename: Isaac
authors.initials: I
authors.lastname: Zulu
authors.forename: Stanley
authors.initials: S
authors.lastname: Trask
authors.forename: Ulgen
authors.initials: U
authors.lastname: Fideli
authors.forename: Rosemary
authors.initials: R
authors.lastname: Musonda
authors.forename: Francis
authors.initials: F
authors.lastname: Kasolo
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Alan
authors.initials: A
authors.lastname: Haworth
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003376:Counseling; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014342:Truth Disclosure; D015024:Zambia