Risk HIV or remain childless, the dilemma of discordance

HIV-discordant couples in their child-bearing years face a life-changing decision: to remain childless or risk the HIV-negative partner contracting the virus for the sake of having a child.

"People get married to procreate, so when couples find out that they are discordant, the biggest challenge is what to do about having children," said Churchill Kamau*, of Discordant Couples of Kenya (DISCOK), a non-governmental organisation (NGO) that supports people in such relationships.

"We are finding, at least in our organisation, that the couples are willing to risk infection for the sake of a child." Kamau is HIV-negative, but discovered his wife was HIV-positive when she fell pregnant in 2005.

Their child is HIV-negative, thanks to a prevention of mother-to-child transmission (PMTCT) programme provided by the antenatal clinic, but he is not certain they would try to have another baby. "At the moment I would say no, but I can't rule it out in the long term," Kamau told IRIN/PlusNews.

Alternative reproduction options that could protect the HIV-negative partner exist: sperm washing when the man is HIV-positive, or artificial insemination when the woman is HIV-positive, but most Kenyan couples are too poor to afford these methods, and instead opt for unprotected intercourse.

According to the Carol Ngare, manager of Voluntary Counselling and Testing (VCT) for the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), about 13 percent of married couples who attended VCT services in Kenya were HIV discordant.

"Because of easily accessible PMTCT, most couples now know that even if one passes the virus on to the other, they are unlikely to pass it on to their child," Kamau said. "They are also aware of free ARVs [antiretroviral drugs], so they are more confident of being around to see the child grow up, even if they do contract the virus."

He stressed the need for couples to be aware of their options, and said the government should work with groups like DISCOK to reach discordant couples, who were often secretive because they were afraid of being stigmatised.

"For instance, I have never told my family that my wife is HIV-positive - they would pressure me to leave her," Kamau said. "For many couples, it is the same; they do not access information because they are afraid of disclosing their discordance to the wider community."

According to NASCOP, couples are encouraged to go for testing together, so they can know each other's status and decide how to proceed if they discover they are discordant.

"The counselling messages aim at giving them the disadvantages and benefits of getting pregnant, and ensuring that whatever choice they make is through informed consent," Carol Ngare, voluntary counselling and testing manager at NASCOP, told IRIN/PlusNews. "Whatever choice they make, they will be supported in counselling and treatment, where required, through PMTCT."

However, the proportion of people who visit these centres with their partners is below 10 percent, and DISCOK's Kamau said the government should run a campaign specifically encouraging couples to do so.

Edward Gene, Kenya, "I couldn't believe she was HIV-positive and I was HIV-negative"
NIGERIA: Supporting discordant couples to stay together

kr/he/kn