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HIV Testing and Counseling Leads to Immediate Consistent Condom Use Among South African Stable HIV-Discordant Couples

Rosenberg, Nora E. PhD, MSPH*; Pettifor, Audrey E. PhD*,†; Bruyn, Guy De MBBCh, PhD‡,§; Westreich, Daniel PhD; Delany-Moretlwe, Sinead MBBCh, PhD; Behets, Frieda PhD*,¶; Maman, Suzanne PhD#; Coetzee, David MD, MS**; Kamupira, Mercy MBChB, PhD, MPH**; Miller, William C. MD, PhD, MPH*,¶

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2013 - Volume 62 - Issue 2 - p 226–233
doi: 10.1097/QAI.0b013e31827971ca
Epidemiology and Prevention

Objective: Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples.

Methods: Partners in Prevention HSV/HIV Transmission Study was a randomized trial conducted from 2004 to 2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1–coinfected persons to HIV-uninfected sex partners. This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants. The exposure was timing of first HIV testing and counseling: 0–7, 8–14, 15–30, or >30 days before baseline. In each exposure group, predicted probabilities of unprotected sex in the last month were calculated at baseline, month 1, and month 12 using generalized estimating equations with a logit link and exchangeable correlation matrix.

Results: At baseline, participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month: 0–7 days, 0.71; 8–14 days, 0.52; 15–30 days, 0.49; >30 days, 0.26. At month 1, once all participants had been aware of being in HIV-discordant relationships for ≥1 month, predicted probabilities declined: 0–7 days, 0.08; 8–14 days, 0.08; 15–30 days, 0.15; >30 days, 0.14. Lower predicted probabilities were sustained through month 12: 0–7 days, 0.08; 8–14 days, 0.11; 15–30 days, 0.05; >30 days, 0.19.

Conclusions: Unprotected sex declined after HIV-positive diagnosis and declined further after awareness of HIV discordance. Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk.

*Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Wits Reproductive Health and HIV Institute and

Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa

§Sanofi Pasteur, Swiftwater, PA

Department of Obstetrics and Gynecology and Duke Global Health Institute, Duke University, Durham

Departments of Medicine and

#Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill

**Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.

Correspondence to: Nora E. Rosenberg, PhD, MSPH, Department of Epidemiology, CB #7435, McGavran-Greenberg Bldg, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435 (e-mail:

Supported by 5-R01AI083059-03 awarded to W. C. Miller and A. E. Pettifor and by the Center for AIDS Research P30-AI064518-06 awarded to D. Westreich. The parent study (Partners in Prevention HSV/HIV Transmission Study) was funded by the Bill & Melinda Gates Foundation (Grant number 26469).

Presented at South African AIDS Conference, June 9, 2011 and XIX International AIDS Conference, July 26, 2012.

N. E. Rosenberg was supported by the DHHS/NIH/NIAID (T32 AI 007001-34) Training in Sexually Transmitted Diseases and HIV and the John Motley Morehead Fellowship awarded by the Graduate School at the University of North Carolina at Chapel Hill, the Cornoni-Huntley Endowed Scholarship in Epidemiology from the Department of Epidemiology, and the Winstanly Scholarship from the Gillings School of Global Public Health. Since the completion of data collection, G. De Bruyn accepted a position at Sanofi Pasteur. Sanofi Pasteur had no role in this manuscript.

The authors have no other conflicts of interest to disclose.

N. E. Rosenberg conceptualized the study, in collaboration with A. E. Pettifor, W. C. Miller, D. Westreich, F. Behets, S. Maman, S. Delany-Moretlwe, and G. De Bruyn. S. Delany-Moretlwe, G. De Bruyn, and D. Coetzee were site PIs on the parent study. S. Delany-Moretlwe, G. De Bruyn, D. Coetzee, and M. Kamupira oversaw laboratory and clinical aspects of the parent study, and data collection. Data analysis and interpretation were performed by N. E. Rosenberg, under the guidance of W. C. Miller and A. E. Pettifor. N. E. Rosenberg prepared the initial draft manuscript, and revisions were made by A. E. Pettifor, W. C. Miller, S. Delany-Moretlwe, G. De Bruyn, D. Westreich, F. Behets, S. Maman, D. Coetzee, and M. Kamupira.

Received August 12, 2012

Accepted October 12, 2012

© 2013 Lippincott Williams & Wilkins, Inc.