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Evolution of Couples' Voluntary Counseling and Testing for HIV in Lusaka, Zambia

Chomba, Elwyn MD*†; Allen, Susan MD, MPH, DTM&H*‡; Kanweka, William MD, MPH*; Tichacek, Amanda MPH*‡; Cox, Garrett MPH*; Shutes, Erin MPH*; Zulu, Isaac MD, MPH*†; Kancheya, Nzali MD, MPH*†; Sinkala, Moses MD, MPH; Stephenson, Rob MSc, PhD; Haworth, Alan MD*†the Rwanda Zambia HIV Research Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2008 - Volume 47 - Issue 1 - p 108-115
doi: 10.1097/QAI.0b013e31815b2d67
Epidemiology and Social Science

Background: We describe promotional strategies for couples' voluntary HIV counseling and testing (CVCT) and demographic risk factors for couples in Lusaka, Zambia, where an estimated two thirds of new infections occur in cohabiting couples.

Principal Findings: CVCT attendance as a function of promotional strategies is described over a 6-year period. Cross-sectional analyses of risk factors associated with HIV in men, women, and couples are presented. Community workers (CWs) recruited from couples seeking CVCT promoted testing in their communities. Attendance dropped when CW outreach ended, despite continued mass media advertisements. In Lusaka, 51% of 8500 cohabiting couples who sought HIV testing were concordant negative for HIV (MF) and 26% concordant positive (M+F+); 23% had 1 HIV-positive partner and one HIV-negative partner, with 11% HIV-positive man/HIV-negative woman (M+F) and 12% HIV-negative man/HIV-positive woman (F+M). HIV infection was associated with men's age 30 to 39, women's age 25 to 34, duration of union <3 years, and number of children <2. Even among couples with either 1 or 2 or no risk factors, HIV prevalence was 45% and 29%, respectively.

Conclusions: Many married African adults do not have high-risk profiles, nor realize that only 1 may be HIV positive. Active and sustained promotion is needed to encourage all couples to be jointly tested and counseled.

From the *Zambia-Emory HIV Research Project, Lusaka, Zambia; †School of Medicine, University of Zambia, Lusaka, Zambia; ‡Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and the §Zambian Ministry of Health, Lusaka, Zambia.

Received for publication April 6, 2007; accepted September 13, 2007.

Supported in whole or in part by the US National Institutes of Health under grants RO1 HD 40125, RO1 MH 66767, RO1 AI40951, and P30 AI27767; the Fogarty AIDS International Training and Research Program (AITRP) FIC 2D43 TW001042; the Social & Behavioral Core of the Emory Center for AIDS Research (CFAR) P30 AI050409; and the International AIDS Vaccine Initiative (IAVI).

Correspondence to: Susan Allen, MD, MPH, DTM&H, Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1520 Clifton Road NE, Suite 234, Atlanta, GA 30322 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.