XVIII International AIDS Conference


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Persistent HIV transmission risk behaviors among HIV-serodiscordant couples in South Brazil

M.P. Paganella1, L.R. Motta1, S.K. Kato2, R.D. Sperhacke1, C.D. Pilcher3, O.M. Bacon3, F.M. Hecht3, R.S. Souza1

1University of Caxias do Sul, HIV/AIDS Research Laboratory, Caxias do Sul, Brazil, 2Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil, 3University of California at San Francisco, San Francisco, United States

Background: The rate of HIV infection is increasing in the South region of Brazil, despite wide availability of free HIV care. We wished to assess HIV transmission risk behaviors in couples where one partner already knew he or she was HIV+ (HIV serodiscordant couples).
Methods: The AMPLIAR project enrolls individuals with previously HIV - or unknown status at the time they seek routine HIV voluntary counseling in South Brazil. The study collects information concerning clinical and sociodemographic factors, HIV transmission risk behavior and sexual partnerships from all subjects. Testing for HIV infection includes staging of infections as 'recent' (< 6 months) using the BED capture EIA.
Results: Among 3591 HIV testers studied during 2006-2009, we identified 489 (14%) who were in HIV discordant steady partnerships and 3102 (86%) with only HIV-/unknown partnerships. The mean rate of sexual intercourse reported within HIV discordant couples (4.7 acts/2 weeks) was slightly greater than that reported by other participants (3.0 acts/ 2 wks; p=NS). HIV discordant couples reported low rates of condom use, with 34.6% reporting inconsistent and 33.5% reporting no condom use within the partnership. Main reasons for not using condoms in discordant couples included “trust in the partner” (36.0%), “don't like to use it” (20.1%) and “partner does not accept using it” (11.6%). Individuals in discordant couples who reported no or inconsistent condom use were significantly more likely to be newly HIV+ (OR 4.0 (95CI: 2.2, 7.1).
Conclusions: Despite the broad availability of HIV care and prevention services in Brazil, individuals in HIV-discordant partnerships continue to engage in frequent HIV transmission risk behaviors and to transmit HIV. Reasons for this are often related to interpersonal dynamics within couples. To combat HIV in South Brazil, increased efforts are needed that focus on HIV prevention in couples.

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