Discordance: Living with the virus under one blanket
Dec 21, 2008
MARY, 35 and Mike, 45 have been married for 16 years and have four children. Until recently, they did not know Mike was HIV-positive. When Mike was tested for HIV at a mobile counselling and testing centre, he did not believe his results. He said before marriage, he had never had sex.
By Joseph Matovu
MARY, 35 and Mike, 45 have been married for 16 years and have four children. Until recently, they did not know Mike was HIV-positive. When Mike was tested for HIV at a mobile counselling and testing centre, he did not believe his results. He said before marriage, he had never had sex.
“May be it is my wife who infected me.†However, when Mike and his wife tested together, she turned out to be HIV-negative. This situation where one partner is infected with HIV and the other one is not is called HIV discordance.
Mary and Mike are not the only couple in this situation. Many couples have got married when one of them is infected with HIV, but unaware of this.
A national HIV/AIDS sero-behavioural survey done by the Ministry of Health in 2004-2005 found that up to 5% of 4,000 cohabiting couples were discordant.
Another study in Tororo, eastern Uganda, found that up to 43% of HIV-infected people had partners who were HIV-negative.
Reacting to the high percentage of HIV discordant couples, Dr Alex Opio in the Ministry of Health said: “It is strange, but we think it is partly because there are more people on anti-retroviral therapy, which gives people a longer life.
It is something we have to address quickly because this friendly fire infection is very dangerous to our HIV control measures.â€
What is worrying is that many of these couples do not know or even believe that such a situation can exist and continue to live with HIV under the same blanket unknowingly.
In a recent study by R. Bunnell and colleagues, eight in 10 couples interviewed did not believe that HIV discordance was possible within couples, and of these, nine out of every 10 couples did not know the HIV status of their partners.
One can argue that it is not surprising that couples find it difficult to understand HIV discordance. Married couples have sex regularly and since HIV is transmitted through sex, how can one explain the presence of HIV in one but not the other partner?
Couples have indeed expressed their inability to understand this situation: “I have failed to understand how this [HIV discordance] can happen. Up to now I cannot believe that I am HIV-negative when my partner is HIV-positive,†said one of the HIV-negative partners interviewed by Bunnell.
This inability to fully understand, let alone, explain HIV discordance is not restricted to individuals and couples. In a 2005 study, Bunnell found that HIV test counsellors were as confused about what causes discordance as the explanations provided: “[Discordance] may mean that she is infected but the body has not yet manufactured enough antibodies to be detected by the testing machines.
This means that there is a possibility that both of you may be infected,†explained one of the counsellors interviewed for this study.
The apparent lack of knowledge about HIV-discordance has affected efforts to encourage couples to test together.
Studies suggest that only between 10-30% of couples come together for HIV testing, mainly because of fear for couples to test together for HIV but also due to beliefs that once one of them is tested, the other partner’s HIV status should automatically be similar to that for the tested partner.
In the many cases, couples have tested without their partners and have not disclosed their HIV status to them.
In the event that they disclose, they usually do so to non-sexual partners first and may take as long as two years or even more before disclosing to their sexual partners. In this situation of unawareness, people continue to engage in unprotected sex, resulting in high levels of transmission of HIV within couples.
These findings suggest a need for increased sensitisation about HIV discordance and the implications of living in a discordant relationship unknowingly.
The health education division of the Ministry of Health should come up with easy-to-understand messages about HIV discordance which should be disseminated in communities, schools and churches in much the same way as it was in the 1980s when the epidemic had just struck.
As awareness increases, they will be motivated to test jointly or disclose their HIV status to their partners. Those who are HIV-positive can be supported to reduce the risk of transmitting HIV to their partners.
A recent study by Uganda AIDS Commission suggests that 43% of new infections occurred among married couples, majority of whom were living with HIV-infected partners.
In order to fight HIV among married couples, there is need for increased awareness that HIV discordance is common among married couples.
It is also important to emphasise that as people continue to live with HIV infected partners unknowingly, the risk of acquiring HIV is as high as 10-12% per year.
This means that 10-12% of individuals living with HIV infected partners will become infected with HIV every year if they don’t adopt any protective measures to guard against HIV.
The writer works with the School of Public Health, Makerere University
MARY, 35 and Mike, 45 have been married for 16 years and have four children. Until recently, they did not know Mike was HIV-positive. When Mike was tested for HIV at a mobile counselling and testing centre, he did not believe his results. He said before marriage, he had never had sex.
“May be it is my wife who infected me.†However, when Mike and his wife tested together, she turned out to be HIV-negative. This situation where one partner is infected with HIV and the other one is not is called HIV discordance.
Mary and Mike are not the only couple in this situation. Many couples have got married when one of them is infected with HIV, but unaware of this.
A national HIV/AIDS sero-behavioural survey done by the Ministry of Health in 2004-2005 found that up to 5% of 4,000 cohabiting couples were discordant.
Another study in Tororo, eastern Uganda, found that up to 43% of HIV-infected people had partners who were HIV-negative.
Reacting to the high percentage of HIV discordant couples, Dr Alex Opio in the Ministry of Health said: “It is strange, but we think it is partly because there are more people on anti-retroviral therapy, which gives people a longer life.
It is something we have to address quickly because this friendly fire infection is very dangerous to our HIV control measures.â€
What is worrying is that many of these couples do not know or even believe that such a situation can exist and continue to live with HIV under the same blanket unknowingly.
In a recent study by R. Bunnell and colleagues, eight in 10 couples interviewed did not believe that HIV discordance was possible within couples, and of these, nine out of every 10 couples did not know the HIV status of their partners.
One can argue that it is not surprising that couples find it difficult to understand HIV discordance. Married couples have sex regularly and since HIV is transmitted through sex, how can one explain the presence of HIV in one but not the other partner?
Couples have indeed expressed their inability to understand this situation: “I have failed to understand how this [HIV discordance] can happen. Up to now I cannot believe that I am HIV-negative when my partner is HIV-positive,†said one of the HIV-negative partners interviewed by Bunnell.
This inability to fully understand, let alone, explain HIV discordance is not restricted to individuals and couples. In a 2005 study, Bunnell found that HIV test counsellors were as confused about what causes discordance as the explanations provided: “[Discordance] may mean that she is infected but the body has not yet manufactured enough antibodies to be detected by the testing machines.
This means that there is a possibility that both of you may be infected,†explained one of the counsellors interviewed for this study.
The apparent lack of knowledge about HIV-discordance has affected efforts to encourage couples to test together.
Studies suggest that only between 10-30% of couples come together for HIV testing, mainly because of fear for couples to test together for HIV but also due to beliefs that once one of them is tested, the other partner’s HIV status should automatically be similar to that for the tested partner.
In the many cases, couples have tested without their partners and have not disclosed their HIV status to them.
In the event that they disclose, they usually do so to non-sexual partners first and may take as long as two years or even more before disclosing to their sexual partners. In this situation of unawareness, people continue to engage in unprotected sex, resulting in high levels of transmission of HIV within couples.
These findings suggest a need for increased sensitisation about HIV discordance and the implications of living in a discordant relationship unknowingly.
The health education division of the Ministry of Health should come up with easy-to-understand messages about HIV discordance which should be disseminated in communities, schools and churches in much the same way as it was in the 1980s when the epidemic had just struck.
As awareness increases, they will be motivated to test jointly or disclose their HIV status to their partners. Those who are HIV-positive can be supported to reduce the risk of transmitting HIV to their partners.
A recent study by Uganda AIDS Commission suggests that 43% of new infections occurred among married couples, majority of whom were living with HIV-infected partners.
In order to fight HIV among married couples, there is need for increased awareness that HIV discordance is common among married couples.
It is also important to emphasise that as people continue to live with HIV infected partners unknowingly, the risk of acquiring HIV is as high as 10-12% per year.
This means that 10-12% of individuals living with HIV infected partners will become infected with HIV every year if they don’t adopt any protective measures to guard against HIV.
The writer works with the School of Public Health, Makerere University