title: Low uptake of HIV testing and no HIV positivity in stable serodiscordant heterosexual partners of long-term treated HIV-infected Thais.
abstract: The objective of this study was to characterize HIV-serodiscordant heterosexual couples and to evaluate acceptance for HIV testing and HIV prevalence in nonindex partners. We conducted a cross-sectional study with quantitative and qualitative components. Two cohorts of 1767 HIV-positive people were screened to identify heterosexual HIV-serodiscordant couples. HIV-positive partners (index) were administered a questionnaire; CD4, viral load (VL), and antiretroviral therapy (ART) history were gathered from clinical records. HIV-negative/unknown status partners (nonindex) were invited for a similar questionnaire and HIV testing. In-depth interviews with three HIV-serodiscordant couples were conducted. Two hundred and ninety-seven index partners agreed to enroll in this study. The median duration of the relationship was 10 years, and 81% were sexually active. All but two index partners were on ART, and 98% had VL < 1000 copies/mL. Only 111 (37%) nonindex partners came for HIV testing, and all of them tested HIV-negative. In addition, only 41% of nonindex partners had HIV testing in the last one year. The main reasons for the nonindex partners not to come for HIV testing were "no interest" (n = 117, 63%) and "nondisclosure of HIV status" (n = 46, 25%). The latter was substantiated and explained by the qualitative outcome of this study, suggesting relation to stigma against HIV-positive people. Our results support the WHO recommendation for starting ART for treatment and prevention in HIV-serodiscordant couples at any CD4 count. Furthermore, we recommend the dissemination of data showing that no HIV transmission in heterosexual couples through sex practice has been observed provided VL is suppressed. This could be a powerful tool for effective fight against stigma and self-stigma in people living with HIV.
authors.affiliation: a The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) , Bangkok , Thailand.
authors.forename: Nadia
authors.initials: N
authors.lastname: Kancheva Landolt
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.forename: Chuleeporn
authors.initials: C
authors.lastname: Khongpetch
authors.forename: Rosalin
authors.initials: R
authors.lastname: Kriengsinyot
authors.forename: Somsong
authors.initials: S
authors.lastname: Teeratakulpisarn
authors.forename: Sasiwimol
authors.initials: S
authors.lastname: Ubolyam
authors.forename: Stephen
authors.initials: S
authors.lastname: Kerr
authors.forename: Suteeraporn
authors.initials: S
authors.lastname: Pinyakorn
authors.forename: Surasith
authors.initials: S
authors.lastname: Chaithongwongwatthana
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D018023:HIV Seronegativity; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: ART and HIV transmission; HIV testing; heterosexual HIV-serodiscordant couples; stigma