title: Women in couples antenatal HIV counseling and testing are not more likely to report adverse social events.
abstract: BACKGROUND
  Couple counseling has been promoted as a strategy to improve uptake of interventions to prevent mother-to-child HIV transmission (pMTCT) and to minimize adverse social outcomes associated with disclosure of HIV status.
  
  
  OBJECTIVE
  We tested whether women counseled antenatally as part of a couple were more likely to accept HIV testing and nevirapine in a pMTCT program, and whether they would be less likely to experience later adverse social events than women counseled alone.
  
  
  METHODS
  A pMTCT program that included active community education and outreach to encourage couple counseling and testing was implemented in two antenatal clinics in Lusaka, Zambia. A subset of HIV-positive women was asked to report their experience of adverse social events 6 months after delivery. Couple-counseled women were compared with individual-counseled women stratified by whether or not they had disclosed their HIV status to their partners.
  
  
  RESULTS
  Nine percent (868) of 9409 women counseled antenatally were counseled with their husband. Couple-counseled women were more likely to accept HIV testing (96%) than women counseled alone (79%); however uptake of nevirapine was not improved. Six months after delivery, 28% of 324 HIV-positive women reported at least one adverse social event (including physical violence, verbal abuse, divorce or separation). There were no significant differences in reported adverse social events between couple- and individual-counseled women.
  
  
  CONCLUSIONS
  Couple counseling did not increase the risk of adverse social events associated with HIV disclosure. Support services and interventions to improve social situations for people living with HIV need to be further evaluated.
authors.affiliation: Center for International Health and Development at the Boston University School of Public Health, Boston, Massachusetts 02118, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Erin
authors.initials: E
authors.lastname: Shutes
authors.forename: Grace
authors.initials: G
authors.lastname: Aldrovandi
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding; D015331:Cohort Studies; D003376:Counseling / Q000706:statistics & numerical data*; D030881:Disclosure; D004243:Divorce; D017579:Domestic Violence; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine