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HIV
status among discordant couples in Sub-Saharan Africa: an analysis
involving more than 13,000 discordant couples
Presented by Oghenowede Eyawo (Canada).
O. Eyawo1, D. de Walque2, N. Ford3, G. Gakaii4, R. Lester5, E. Mills6
1UBC, Vancouver, Canada, 2World Bank, Washington, United States, 3University of Cape Town, Cape Town, South Africa, 4University of Nairobi, Nairobi, Kenya, 5University of British Columbia, Vancouver, Canada, 6University of Hawaii, Honolulu, United States
Background:
The majority of couples
affected by HIV/AIDS in sun-Saharan Africa live in discordant relationships,
where one is HIV+ and the other is not. There has been an expectation that men
represent the most common index client in relationships and, as a result, most
social marketing and awareness campaigns are focused on men.
Methods:
We conducted a systematic
review, random-effects meta-analysis, and meta-regression of all studies
enrolling discordant couples and assessed the proportion of males and females
as index clients. We supplemented this analysis using Demographic and Health
Surveys (DHS) data from the 14 countries that have detailed HIV status on
couples.
Results:
We included data from 27
cohorts involving 12,865 couples as well as DHS data from 1,145 couples. We
found that, on average, females were as likely as men to be the index client in
a relationship (47% , 95% Confidence Interval [CI]: 43-52%; tau 2= 0.18). This was similar in the DHS
studies (46%, 95% CI, 41-51%, tau2= 0.07). Meta-regression found that urban vs rural
residence, latitude, gender equity, HIV prevalence, and older age were
associated with the effect size.
Conclusions:
Our study demonstrates the
need to focus on both genders when promoting condom use and mitigating risk
behaviors.
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