HIV serodiscordant relationships in India: translating science to practice

Sexual behavior and contraceptive practices: Study among married heterosexual HIV serodiscordant couples of reproductive age group attending anti-retroviral therapy centre at a Tertiary care hospital in Mumbai, India

Background:

As many as half of people with HIV who are in a long-term sexual relationship have an HIV-negative partner. Data on sexual behavior and contraceptive needs of heterosexual serodiscordant couples are scarce in India. Keeping these facts in mind, it was considered imperative to conduct a study on sexual behavior, contraceptive practices and associated high risk factors among heterosexual serodiscordant couples.

Objectives:

The objective of the study was to assess the sexual behavior, current contraceptive practices and various risk factors of HIV transmission among married heterosexual HIV serodiscordant couples.

Materials and Methods:

Descriptive study conducted at antiretroviral therapy (ART) centre from where 100 discordant couples were included, data were collected related to their sexual practices, knowledge about different contraception methods and high risk factors related to infection transmission were recorded.

Results:

All couples had knowledge of use of condoms (100%) while consistent usage was seen only in 18%. The high risk of HIV transmission was seen among recently married serodiscordant couples. Couples engaged in daily intercourse were more likely to have high risk of transmission (P value < 0.05).

Conclusion:

This study showed various risk factors for infection transmission to the seronegative partner among serodiscordant couples. Henceforth, given conception that prevention of these factors could reduce overall seroconversion rate among such couples.

Socio- demographic correlates of HIV sero-discordance among couples in West Bengal, India; A cross sectional analysis

Serodiscordant couples serves as potential source of Human Immunodeficiency Virus (HIV) transmission. Understanding demographic dynamics of serodiscordant couples plays an important role in tailoring interventions towards eliminating HIV. We conducted this cross sectional analysis in 314 Integrated Counseling and Testing Centres (ICTCs) in West Bengal, India during April 2016 to March 2020. General individuals who were detected as HIV reactive and whose spouses were also tested for HIV comprised the study population (8740 couples). Sociodemographic variables were compared across concordant and discordant arms and also between male positive (M+ F-) and female positive (F+ M-) subgroups of serodiscordant. Among the couples studied, 35.2% (95% CI: 34.2- 36.2 %) were serodiscordant. Among serodiscordant couples, the proportion of M+ F- (86.1%) was significantly higher than F+ M- (13.9%). We observed higher mean ages of couples, higher education, business & service occupations and urban residence as significantly associated with serodiscordance relationship (p < 0.05). Higher mean age of couple and lower proportion of housewives were associated with F+M- subgroup. As around 35% serodiscordant couples carry the risk of transmission to negative spouses particularly in higher age and urban residence, thus reorientation of HIV programme may be required accordingly to avert transmission in future.

"It Had a Lot of Cultural Stuff in It": HIV-Serodiscordant African American Couples' Experiences of a Culturally Congruent Sexual Health Intervention

Objective

The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shaping sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention.

Participants

Participants (n=17) who completed at least half of the eight intervention sessions.

Methods

Brief post-implementation semi-structured interviews were conducted between January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains.

Results

Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Participants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the sessions, including the emphasis on learning from one another as couples.

Conclusions

Couples at risk for HIV transmission benefit from strengthening skills and knowledge related to healthy sexuality. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also reducing risk.

Are partners of HIV-infected people being tested for HIV? A mixed-methods research from Gujarat, India

Setting: Four selected antiretroviral therapy (ART) centres of Gujarat State, India, which accounts for 8% of the human immunodeficiency virus (HIV) burden in India. Objectives: 1) To assess the proportion of people living with HIV (PLHIV) whose partners were not tested for HIV; 2) to assess sociodemographic and clinical characteristics of index cases associated with partner testing; and 3) to understand perceived facilitators and barriers to partner testing and make suggestions on how to improve testing from the perspective of the health-care provider. Design: A mixed-method design with a quantitative phase that involved reviewing the programme records of married PLHIV enrolled during 2011-2015, followed by a qualitative phase of key informant interviews. Results: Of 3884 married PLHIV, 1279 (33%) did not have their partners tested for HIV. Factors including index cases being male, illiterate, aged >25 years, belonging to key populations, substance use and being in advanced clinical stages were more likely to be associated with partner non-testing. Non-disclosure of HIV status (due to fear of marital discord) and lack of awareness and risk perception were the key barriers to testing. Conclusion: One third of PLHIV did not have their partners tested for HIV. Several factors were identified as being associated with the non-testing of partners, and solutions were explored that need to be implemented urgently if we are to achieve the 90-90-90 targets and end HIV.

Providing a gateway to prevention and care for the most at-risk populations in Bhutan: is this being achieved?

SETTING

Two free-standing urban human immunodeficiency virus (HIV) testing and counselling (HCT) centres in Bhutan offering services to the general population and targeting the most at-risk populations (MARPs).

OBJECTIVES

To assess the trend in testing for HIV, hepatitis B and syphilis in both the general population and MARPs, and to determine if sociodemographic and risk behaviour characteristics are associated with HIV, hepatitis B and syphilis seropositivity.

DESIGN

Cross-sectional study using client records, 2009 - 2012.

RESULTS

Of 7894 clients, 3009 (38%) were from the general population, while 4885 (62%) were from MARPs. Over the 4-year period, testing declined progressively among the general population, while it increased or remained static for MARPs. Of 4885 MARPs, seropositivity was respectively 0.7%, 1.3% and 1.2% for HIV, hepatitis B and syphilis. Female sex workers (FSWs) (relative risk [RR] 4.4, P = 0.03) and partners of person living with HIV (RR 25.9, P < 0.001) had a higher risk of being HIV-positive. FSWs had also a greater risk of being syphilis-positive (RR 9.1, P < 0.001).

CONCLUSION

The increase in uptake of HCT services by MARPs is a welcome finding; however, the relatively static trends call for the introduction of community outreach approaches. The critical gateway being provided to MARPs is an 'opportunity' for the expansion of the current service package.

The other side of the bridge: exploring the sexual relationships of men who have sex with men and their female partners in Mumbai, India

Behaviourally bisexual men have been identified as a 'bridge' population of HIV transmission to heterosexual women in India. Little is known about the sexual relationships that these men have with their female sex partners. The primary objective of this study was to explore the sexual practices and relationship dynamics between married and unmarried behaviourally bisexual men and their female sex partners in Mumbai, India. In 2009, semi-structured qualitative interviews were conducted with 32 men who reported sex with men and women. Participants discussed a variety of sexual practices and arrangements with female sex partners. Irrespective of marital status and sexual identity, many said that they had satisfying sexual experiences and feelings of affection for female sex partners. However, sexual incompatibility between married partners was also reported. Explanations of bisexual concurrency were discussed in terms of both sexual satisfaction and sexual preference. Self-perceived HIV risk related to same-sex sexual behaviour motivated many men to use condoms with female partners. Expectations of unprotected marital sex and perceptions of partner risk were barriers to condom use. HIV-prevention programmes for this population may benefit from tailored risk-reduction counselling that attends to the variations of these sexual and social relationship dynamics.

Ethical issues in obtaining collateral information on alcohol and drug use: experience from Asia and Africa

PURPOSE OF REVIEW

In many regions of the world, wives of alcohol and drug-using men are at an increased risk for HIV/AIDS because of their husbands' high-risk behaviours. These women also tend to be poor, illiterate and dependent on their husbands. Few interventions are designed exclusively for these women. Furthermore, these interventions have had to obtain permission from the husbands to recruit the wives. This article discusses the ethical concerns in obtaining husbands' permission to recruit their wives, with examples taken from India and other countries in Asia and Africa.

RECENT FINDINGS

Studies indicate that married women are recruited for interventions only with their husbands' consent. Researchers reported that this strategy was acceptable to the local culture, increased acceptance of the research by family and community and improved the participation rate of married women. However, this strategy conflicts with the ethical principles of individual autonomy and voluntariness.

SUMMARY

Designing research processes according to the local cultural norms is important. However, it is a researcher's ethical duty to ensure that every individual of the society, irrespective of sex, race or marital status, gets equal opportunities to make health-related decisions. This article suggests alternate strategies to directly approach and recruit monogamous wives of alcohol and drug-using men; further research is required to test the feasibility of suggested strategies.

Changing epidemiology of HIV in Mumbai: an application of the Asian epidemic model

Background:

Mumbai is one of the most populous and high HIV prevalence cities in India. It has witnessed substantial changes in HIV-risk behaviors and a decline in HIV prevalence among high-risk groups during the past decade.

Aim:

To examine the changing pattern in the number of new HIV infections by transmission routes in Mumbai during 2000-2017.

Methods:

We used the Asian Epidemic Model by dividing the adult population (aged 15 and above) into seven subgroups: brothel-based and non-brothel based female sex workers (FSWs), heterosexual clients of FSWs, men who have sex with men/transgendered people (MSM), injecting drug users (IDUs), general women and general men. The MSM subgroup included homosexual and bisexual men.

Results:

New HIV infections among adults reduced by 86% during 2000-2010. The highest decline was among FSWs and their heterosexual clients (95%-98%), followed by MSM (82%), general women (77%), IDUs (51%) and general men (42%). Most new HIV infections during 2011-2017 are expected to occur among general women (1666) and general men (977) followed by MSM (715). Bisexual men were estimated to contribute about 14% of the new HIV infections among general women in 2010 and this proportion was estimated to increase to 19% in 2017.

Discussion:

HIV prevention programs for MSM and the general population need to be strengthened. Ensuring early detection of HIV, and higher levels of consistent condom use by HIV-infected men and women are essential to prevent new HIV infections in future.