Antiretroviral treatment significantly reduces the risk of HIV transmission between married couples where one partner is infected and the other is not, according to a recent study in Uganda.
The retrospective study, published in the official Journal of the International AIDS Society in February, followed 250 HIV-discordant couples in the central Ugandan district of Rakai between 2004 and 2009. During the study period, 32 HIV-positive partners started ART.
"We found that after starting ART, there were no HIV transmissions among the couples we studied," said Steven Reynolds, a professor at Johns Hopkins University School of Medicine and lead author of the study.
The research - part of a larger community cohort study of individuals in Rakai that has been ongoing since 1994 - found that the viral load of HIV-infected people dropped noticeably following initiation on ART.
The results are consistent with a seven-country study published in The Lancet in 2010, which found that ART use by the infected person was accompanied by a 92 percent reduction in risk of HIV transmission to their partner.
According to Reynolds, the findings can help inform HIV programming for married couples. "The findings highlight the need to put discordant couples – a priority area for policy-makers – on treatment as soon as they qualify," he said.
The study found that after ART initiation, consistent condom use increased from 14.3 percent before ART use to 53.7 percent; Reynolds said this increase could also partially explain the reduction in HIV transmission. However, there was no significant difference in the number of sexual partners; between 8 and 15 percent of study participants reported having extra-marital sex.
"Scaling up counselling, testing and treating among married couples means the HIV-positive partners in these relationships are identified earlier and programmes are able to intervene to prevent the negative partner becoming infected," he said.
Most new HIV infections in Uganda occur among people in long-term relationships, while an estimated 48 percent of HIV-infected married individuals have HIV-negative partners.
The government has recently focused more attention on HIV prevention among married partners; several ongoing campaigns promote the idea of sexual fidelity. However, these campaigns have faced criticism for failing to address the root causes of infidelity and for their limited reach - most are carried out in large urban centres and are not translated into local languages.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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