Outside sexual partnerships and risk of HIV acquisition for HIV uninfected partners in African HIV serodiscordant partnerships
Ndase, P.; Celum, C.; Thomas, K.; Donnell, D.; Fife, K.H.; Bukusi, E.; Delany-Moretlwe, S.; Baeten, J.M.; Celum, C.; Wald, A.; Lingappa, J.; Baeten, J.M.; Campbell, M.; Corey, L.; Coombs, R.W.; Hughes, J.P.; Magaret, A.; McElrath, M.Juliana.; Morrow, R.; Mullins, J.I.; Coetzee, D.; Fife, K.; Were, E.; Essex, M.; Makhema, J.; Katabira, E.; Ronald, A.; Allen, S.; Kayitenkore, K.; Karita, E.; Bukusi, E.; Cohen, C.; Allen, S.; Kanweka, W.; Allen, S.; Vwalika, B.; Kapiga, S.; Manongi, R.; Farquhar, C
Journal of Acquired Immune Deficiency Syndromes 59(1): 65-71
2012
ISSN/ISBN: 1525-4135 PMID: 21963939 DOI: 10.1097/qai.0b013e318237b864Document Number: 534910
As African countries scale-up couples HIV testing, little is known about sexual behaviors and HIV risk for HIV-uninfected partners in known HIV-serodiscordant relationships. We conducted a prospective study of 3380 HIV-serodiscordant partnerships from 7 African countries. Self-reported sexual behavior data were collected quarterly from HIV-uninfected partners. The proportion of HIV-uninfected partners reporting sex with their known primary HIV-infected partner decreased during follow-up (from 93.5% in the prior month at baseline to 73.2% at 24 months, P < 0.001). Simultaneously, an increasing proportion reported sex with an outside partner (from 3.1% to 13.9%, P < 0.001). A small proportion (<5%, stable throughout follow-up) reported sex with the infected partner and an outside partner in the same month (concurrent). Unprotected sex was more common with outside partners than with their primary known HIV-infected partners (risk ratio 4.6; 95% confidence interval: 4.2 to 5.2). HIV incidence was similar for those reporting sex only with their primary HIV-infected partner compared with those who reported an outside partner (2.87 vs. 3.02 per 100 person-years, P = 0.7), although those who had outside partners were more likely to acquire HIV that was virologically distinct from that of their primary partner (P < 0.001). For uninfected members of HIV-serodiscordant couples, sex with the infected partner declined as sex with outside partners increased, likely reflecting relationship dissolution and risk shifting from a known infected partner. Risk-reduction messages for HIV-uninfected partners in serodiscordant partnerships should include strategies to reduce HIV acquisition from outside partners.