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.

Keywords:

• heterosexual HIV-serodiscordant couples
• ART and HIV transmission
• HIV testing
• stigma

Acknowledgments

We are grateful to all the study participants, as well as to the research and clinical staff and clients at the HIV-NAT Clinic and at the Thai Red Cross Anonymous Clinic for their contribution to this study. The team appreciated the support of Narukjaporn Thammajaruk and Apicha Mahanontharit for their help in the laboratory, Paristaporn Sarachat for helping with data collection, Theeradej Boonmangum and his team for helping with data entry, and Chatsuda Auchieng and Piraporn June Ohata for dealing with administrative issues. The authors have no conflict of interest.

Additional information

Funding

This study was funded by Ratchadapiseksompotch Endowment Fund, Faculty of Medicine, Chulalongkorn University [grant number RA 55/53] and the HIV Netherlands Australia Thailand Research Collaboration.