HIV discordant couples are at the highest risk of HIV transmission and acquisition. A major obstacle in preventing HIV transmission among discordant couples is disclosing their status or knowledge of a partner’s status. We examined the association between the demographic characteristics of discordant couples and their disclosure or knowledge of their partner’s status, using Population-based HIV Impact Assessment (PHIA) surveys conducted (2015-2019) by ministries of health in collaboration with ICAP and CDC.
Consenting adults from randomly selected households in 10 African countries provided demographic and behavioral information and blood samples for HIV testing (Table). We applied multivariable logistic regression using survey weights. Variances were estimated via Taylor series linearization.
A total of 2,352 HIV discordant couples were identified. Compared to men, fewer women reported knowing their partner’s status (HIV- or HIV+) in most countries, ranging from 4% fewer in Rwanda to 12% fewer (75% of males vs. 63% of females) in Malawi, and more women reported having disclosed their status to their partner, ranging from 4% more in Uganda to 17% more in Malawi. Fewer younger discordant couples (15-29 years) knew their partner’s status compared to older couples (30-44 years), ranging from 8% fewer in Malawi to 21% (43% of 15-29 years vs. 22% of 30-44 years) in Zimbabwe, and fewer younger couples (15-29 year) disclosed their status to their partner, ranging from 9% fewer who disclosed in Zambia to 18% fewer in Cameroon. Adjusted for other demographic characteristics, women were less likely to know their partner’s HIV status (adjusted odds ratio (AOR): 0.8; 95% CI: 0.7-0.9) and more likely to disclose their status to their partner (AOR: 1.8; 95% CI: 1.6-2.0). Age-disparate partners, urbanicity, and economic status were not associated with HIV disclosure.
The findings from these nationally representative general population surveys indicate that lack of knowledge of partner’s HIV status among discordant couples is common. This lack of knowledge puts women, especially younger women, at risk for HIV acquisition. Efforts are needed to support disclosure during HIV counseling and in an ongoing manner throughout follow-up.