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Staying Healthy and Reducing Transmission Gap
Research and interventions are needed to better to support people living with HIV with disclosure and reduce stigma so they can adhere to ART and can continue to have a healthy and safer sex life. In-depth interviews with patients in South Africa who were acutely infected found that patients did not retain the information that they are very likely to transmit HIV and that condom use was particularly important, but were focused on identifying who transmitted HIV to them. In addition, patients were still in shock on learning of their HIV status and did not understand how they could be HIV-positive if they tested negative with a rapid HIV test (Wolpaw et al., 2014). Women who were acutely infected in South Africa faced profound "challenges, immediately after HIV diagnosis" (Tomita et al., 2014b: 1118). Focus groups of women living with HIV found that women were concerned that their access to lifelong treatment when becoming pregnant may discourage their men from condom use, as men know that treatment can decrease the risk of transmission.
Staying Healthy and Reducing Transmission
1 study
Additional evidence- and rights-based interventions are needed for couples counseling in sero-discordant relationships; counseling that clearly explains serodiscordance and can identify women at risk of violence and make appropriate links to other services. While WHO issued recommendations on couples testing and counseling (WHO, 2012g), more evidence-based interventions are needed for counseling for couples in sero-discordant relationships. These interventions may need to differ by sex, as in one study, women living with HIV were likely to report an HIV-negative or unknown serostatus partner and men living with HIV were more likely to report multiple sexual partners.
Staying Healthy and Reducing Transmission
1 study
Providers and those living with HIV need accurate information on how HIV is transmitted and how most effectively to reduce the likelihood of transmission among serodiscordant couples (or between those who do not know their sero-status), including those who wish to become pregnant – for their own health and that of their future children. [See also %{s:39}] Studies found that both providers and HIV serodiscordant couples were misinformed as to what factors increase the likelihood of HIV transmission.
Staying Healthy and Reducing Transmission
1 study
Interventions are needed to mitigate adverse events such as stigma or violence when women disclose their serostatus to their partners. [See also %{c:21}] A study found that women who disclosed their positive serostatus to their sexual partners feared abandonment; fear that the relationship would end; and fear of stigma. Of women who disclosed their positive serostatus to their partner, 59.3% experienced a negative reaction, such as violence, break-up of the relationship, being blamed, stigma and abandonment.
Staying Healthy and Reducing Transmission
1 study
Increased detection of acute infection, along with immediate, effective counseling and support is needed. A trial is underway in Botswana to identify those with high viral loads to initiate treatment (Novitsky et al., 2010 cited in Delva and Abdool Karim, 2014).
Staying Healthy and Reducing Transmission
1 study
Intensified efforts are needed to increase male and female condom use and reduce multiple partnerships by people who know their HIV-positive status and are not virally suppressed, including young people. Studies found that consistent condom use between discordant couples (or with partners whose serostatus was unknown) was low and, among those on treatment, decreased over time. Lack of condom use was associated with fear of disclosure. People living with HIV as well as couples also believed that treatment with antiretroviral therapy meant that they were either cured of HIV or could no longer transmit the virus and were less likely to disclose their positive serostatus. In some studies, men are more likely to report condom use than women, "given the limited control that women have over the use of the male condom" (Walusaga et al., 2012: 698). Particular attention is also needed to provide condoms to men living with HIV who frequent sex workers, as well as for sex workers themselves to protect themselves (Paz-Bailey et al., 2012). [See %{s:9}]
Staying Healthy and Reducing Transmission
1 study