HIV sero-discordance among Nigerian couples: challenges and controversies

Abstract

This study was undertaken to determine the prevalence of HIV sero-discordance among couples presenting to the antiretroviral therapy clinic of the University of Port Harcourt Teaching Hospital and to establish the associated risk factors. 100 consecutive couples seen at the antiretroviral therapy clinic and the UNICEF-assisted Prevention of Mother to Child Transmission (PMTCT) of HIV programme were studied. Socio-demographic data of age, gender, occupation, risk group assessment and informed consent were obtained from all subjects. Hepatitis B status of the spouses, sero-positive for HIV was determined. Among the 100 couples tested for HIV sero-positivity, 52% were discordant while 48% were cordant. HIV-I was the predominant viral subtype among those infected in HIV sero-discordant relationship 46/52 (84.6%) compared to 4/52 (7.7%) for HIV-2 and 2/52 (3.9%) for dual HIV 1 and 2. Of the 52 HIV-infected spouses in sero-discordant relationship, 3/52 (5.8%) had Hepatitis B surface antigenaemia. The peak HIV prevalence occurred in the 21-30 years age group. History of extramarital affairs, alcoholism, viral subtype, age range and duration of marriage were seen as independent behavioral and sexual risk factors for HIV infection among spouses that were HIV-infected in sero-discordant relationship. The highest incidence of HIV sero-discordance occurred among couples < 5 years old in marriage. Females accounted for the highest infection burden 32/52 (61.5%) compared to males 20/52 (38.5%) among those HIV-infected in sero-discordant relationship. The highest incidence of HIV infection among sero-discordant couples occurred among housewives. We have obtained HIV sero-discordance prevalence of 52% among the 100 couples visiting the antiretroviral therapy clinic and identified the associated risk factors. We observed that females are more vulnerable to infection among discordant couples. We recommend risk-reduction behavior, empowerment of vulnerable groups, effective life planning skills as well as behavioral change among couples. Early detection of serostatus among couples will enhance timely antiretroviral therapy and reduce the spread of HIV.

Keywords: HIV, sero-discordance, Nigerian, couples

Nigerian Medical Practitioner Vol. 48(3) 2005: 62-66