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. 1992 Jun 20;304(6842):1605–1609. doi: 10.1136/bmj.304.6842.1605

Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa.

S Allen 1, J Tice 1, P Van de Perre 1, A Serufilira 1, E Hudes 1, F Nsengumuremyi 1, J Bogaerts 1, C Lindan 1, S Hulley 1
PMCID: PMC1881972  PMID: 1628088

Abstract

OBJECTIVE--To determine whether HIV testing and counselling increased condom use and decreased heterosexual transmission of HIV in discordant couples. DESIGN--Prospective study. SETTING--Kigali, the capital of Rwanda. SUBJECTS--Cohabiting couples with discordant HIV serology results. MAIN OUTCOME MEASURES--Condom use in the couple and HIV seroconversion in the negative partners. RESULTS--60 HIV discordant couples were identified, of whom 53 were followed for an average of 2.2 years. The proportion of discordant couples using condoms increased from 4% to 57% after one year of follow up. During follow up two of the 23 HIV negative men and six of the 30 HIV negative women seroconverted (seroconversion rates of 4 and 9 per 100 person years). The rate among women was less than half that estimated for similar women in discordant couples whose partners had not been serotested. Condom use was less common among those who seroconverted (100% v 5%, p = 0.01 in men; 67% v 25%, p = 0.14 in women). CONCLUSIONS--Roughly one in seven cohabiting couples in Kigali have discordant HIV serological results. Confidential HIV serotesting with counselling caused a large increase in condom use and was associated with a lower rate of new HIV infections. HIV testing is a promising intervention for preventing the spread of HIV in African cities.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen S., Lindan C., Serufilira A., Van de Perre P., Rundle A. C., Nsengumuremyi F., Carael M., Schwalbe J., Hulley S. Human immunodeficiency virus infection in urban Rwanda. Demographic and behavioral correlates in a representative sample of childbearing women. JAMA. 1991 Sep 25;266(12):1657–1663. [PubMed] [Google Scholar]
  2. Allen S., Van de perre P., Serufilira A., Lepage P., Carael M., DeClercq A., Tice J., Black D., Nsengumuremyi F., Ziegler J. Human immunodeficiency virus and malaria in a representative sample of childbearing women in Kigali, Rwanda. J Infect Dis. 1991 Jul;164(1):67–71. doi: 10.1093/infdis/164.1.67. [DOI] [PubMed] [Google Scholar]
  3. Cameron D. W., Simonsen J. N., D'Costa L. J., Ronald A. R., Maitha G. M., Gakinya M. N., Cheang M., Ndinya-Achola J. O., Piot P., Brunham R. C. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989 Aug 19;2(8660):403–407. doi: 10.1016/s0140-6736(89)90589-8. [DOI] [PubMed] [Google Scholar]
  4. Carael M., Van de Perre P. H., Lepage P. H., Allen S., Nsengumuremyi F., Van Goethem C., Ntahorutaba M., Nzaramba D., Clumeck N. Human immunodeficiency virus transmission among heterosexual couples in Central Africa. AIDS. 1988 Jun;2(3):201–205. [PubMed] [Google Scholar]
  5. Chin J., Mann J. Global surveillance and forecasting of AIDS. Bull World Health Organ. 1989;67(1):1–7. [PMC free article] [PubMed] [Google Scholar]
  6. Feldblum P. J., Fortney J. A. Condoms, spermicides, and the transmission of human immunodeficiency virus: a review of the literature. Am J Public Health. 1988 Jan;78(1):52–54. doi: 10.2105/ajph.78.1.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fischl M. A., Dickinson G. M., Scott G. B., Klimas N., Fletcher M. A., Parks W. Evaluation of heterosexual partners, children, and household contacts of adults with AIDS. JAMA. 1987 Feb 6;257(5):640–644. [PubMed] [Google Scholar]
  8. Green J. A., Spruance S. L., Wenerstrom G., Piepkorn M. W. Post-herpetic erythema multiforme prevented with prophylactic oral acyclovir. Ann Intern Med. 1985 May;102(5):632–633. doi: 10.7326/0003-4819-102-5-632. [DOI] [PubMed] [Google Scholar]
  9. Hearst N., Hulley S. B. Preventing the heterosexual spread of AIDS. Are we giving our patients the best advice? JAMA. 1988 Apr 22;259(16):2428–2432. [PubMed] [Google Scholar]
  10. Hira S. K., Nkowane B. M., Kamanga J., Wadhawan D., Kavindele D., Macuacua R., Mpoko G., Malek M., Cruess D. F., Perine P. L. Epidemiology of human immunodeficiency virus in families in Lusaka, Zambia. J Acquir Immune Defic Syndr. 1990;3(1):83–86. [PubMed] [Google Scholar]
  11. Holmes K. K., Karon J. M., Kreiss J. The increasing frequency of heterosexually acquired AIDS in the United States, 1983-88. Am J Public Health. 1990 Jul;80(7):858–863. doi: 10.2105/ajph.80.7.858. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Johnson A. M., Laga M. Heterosexual transmission of HIV. AIDS. 1988;2 (Suppl 1):S49–S56. doi: 10.1097/00002030-198800001-00008. [DOI] [PubMed] [Google Scholar]
  13. Johnson A. M., Petherick A., Davidson S. J., Brettle R., Hooker M., Howard L., McLean K. A., Osborne L. E., Robertson R., Sonnex C. Transmission of HIV to heterosexual partners of infected men and women. AIDS. 1989 Jun;3(6):367–372. doi: 10.1097/00002030-198906000-00005. [DOI] [PubMed] [Google Scholar]
  14. Kamenga M., Ryder R. W., Jingu M., Mbuyi N., Mbu L., Behets F., Brown C., Heyward W. L. Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counselling center in Zaire. AIDS. 1991 Jan;5(1):61–67. doi: 10.1097/00002030-199101000-00009. [DOI] [PubMed] [Google Scholar]
  15. King R., Van de Perre P., Allen S., Serufilira A., Homsy J. Predictive value of indeterminate HIV western blot. Lancet. 1991 Nov 16;338(8777):1278–1278. doi: 10.1016/0140-6736(91)92149-v. [DOI] [PubMed] [Google Scholar]
  16. Laga M., Taelman H., Van der Stuyft P., Bonneux L., Vercauteren G., Piot P. Advanced immunodeficiency as a risk factor for heterosexual transmission of HIV. AIDS. 1989 Jun;3(6):361–366. doi: 10.1097/00002030-198906000-00004. [DOI] [PubMed] [Google Scholar]
  17. Larson A. Social context of human immunodeficiency virus transmission in Africa: historical and cultural bases of east and central African sexual relations. Rev Infect Dis. 1989 Sep-Oct;11(5):716–731. doi: 10.1093/clinids/11.5.716. [DOI] [PubMed] [Google Scholar]
  18. Laurian Y., Peynet J., Verroust F. HIV infection in sexual partners of HIV-seropositive patients with hemophilia. N Engl J Med. 1989 Jan 19;320(3):183–183. doi: 10.1056/NEJM198901193200312. [DOI] [PubMed] [Google Scholar]
  19. Lawrence D. N., Jason J. M., Holman R. C., Heine P., Evatt B. L. Sex practice correlates of human immunodeficiency virus transmission and acquired immunodeficiency syndrome incidence in heterosexual partners and offspring of U.S. hemophilic men. Am J Hematol. 1989 Feb;30(2):68–76. doi: 10.1002/ajh.2830300204. [DOI] [PubMed] [Google Scholar]
  20. Mann J., Quinn T. C., Piot P., Bosenge N., Nzilambi N., Kalala M., Francis H., Colebunders R. L., Byers R., Azila P. K. Condom use and HIV infection among prostitutes in Zaire. N Engl J Med. 1987 Feb 5;316(6):345–345. doi: 10.1056/NEJM198702053160616. [DOI] [PubMed] [Google Scholar]
  21. Mertens T. E., Hayes R. J., Smith P. G. Epidemiological methods to study the interaction between HIV infection and other sexually transmitted diseases. AIDS. 1990 Jan;4(1):57–65. doi: 10.1097/00002030-199001000-00008. [DOI] [PubMed] [Google Scholar]
  22. Padian N. S., Shiboski S. C., Jewell N. P. The effect of number of exposures on the risk of heterosexual HIV transmission. J Infect Dis. 1990 May;161(5):883–887. doi: 10.1093/infdis/161.5.883. [DOI] [PubMed] [Google Scholar]
  23. Padian N., Marquis L., Francis D. P., Anderson R. E., Rutherford G. W., O'Malley P. M., Winkelstein W., Jr Male-to-female transmission of human immunodeficiency virus. JAMA. 1987 Aug 14;258(6):788–790. [PubMed] [Google Scholar]
  24. Peterman T. A., Stoneburner R. L., Allen J. R., Jaffe H. W., Curran J. W. Risk of human immunodeficiency virus transmission from heterosexual adults with transfusion-associated infections. JAMA. 1988 Jan 1;259(1):55–58. [PubMed] [Google Scholar]
  25. Robertson J. A., Plant M. A. Alcohol, sex and risks of HIV infection. Drug Alcohol Depend. 1988 Oct;22(1-2):75–78. doi: 10.1016/0376-8716(88)90039-7. [DOI] [PubMed] [Google Scholar]
  26. Ryder R. W., Ndilu M., Hassig S. E., Kamenga M., Sequeira D., Kashamuka M., Francis H., Behets F., Colebunders R. L., Dopagne A. Heterosexual transmission of HIV-1 among employees and their spouses at two large businesses in Zaire. AIDS. 1990 Aug;4(8):725–732. doi: 10.1097/00002030-199008000-00002. [DOI] [PubMed] [Google Scholar]
  27. Sheehan A. HIV. Negative images. Nursing (Lond) 1990 Nov 8;4(22):13–14. [PubMed] [Google Scholar]
  28. Silvestre A. J., Lyter D. W., Valdiserri R. O., Huggins J., Rinaldo C. R., Jr Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session. AIDS. 1989 Oct;3(10):647–650. doi: 10.1097/00002030-198910000-00005. [DOI] [PubMed] [Google Scholar]
  29. Smiley M. L., White G. C., 2nd, Becherer P., Macik G., Matthews T. J., Weinhold K. J., McMillan C., Bolognesi D. Transmission of human immunodeficiency virus to sexual partners of hemophiliacs. Am J Hematol. 1988 May;28(1):27–32. doi: 10.1002/ajh.2830280106. [DOI] [PubMed] [Google Scholar]
  30. Stall R., McKusick L., Wiley J., Coates T. J., Ostrow D. G. Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: the AIDS Behavioral Research Project. Health Educ Q. 1986 Winter;13(4):359–371. doi: 10.1177/109019818601300407. [DOI] [PubMed] [Google Scholar]
  31. Stein Z. A. HIV prevention: the need for methods women can use. Am J Public Health. 1990 Apr;80(4):460–462. doi: 10.2105/ajph.80.4.460. [DOI] [PMC free article] [PubMed] [Google Scholar]

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