Less than half of men in Khayelitsha, a high-risk South African township outside of Cape Town, know whether their partners had ever been tested for HIV and women weren't much more informed, according to a survey of heterosexual couples.
This should encourage efforts to improve HIV testing among women and HIV disclosure among women in heterosexual partnerships, the authors of a study published in the British Medical Journal on 14 July 2014, titled Seek, Test and Disclose: knowledge of HIV testing and serostatus among high-risk couples in a South African township conclude.
Almost 20 percent of South African adults ages 15 to 49 years old were HIV positive in 2012, but social norms and other barriers discourage people from getting tested and disclosing their status, the authors note.
These populations need "a concerted effort to reach far into disadvantaged communities for testing with privacy, and to reduce stigma," said senior author Wendee M. Wechsberg of RTI International in Research Triangle Park, North Carolina.
Fear of isolation from their partner, dependency issues, fear of blame and violence might keep couples from discussing their HIV status and history, Wechsberg told Reuters Health by email.
For the study, the researchers used data on 290 couples in stable, heterosexual relationships in Khayelitsha, a township in Cape Town with high HIV infection rates. They recruited men ages 18 to 35 from informal drinking venues and screened their female partners as well.
The partners had separate appointments where they were confidentially tested for HIV and recent drug use, and were asked if they knew whether their partners had ever been tested for HIV and if they knew their partners' HIV status.
According to blood tests, one in five people in the study was HIV-positive. In 69 percent of partnerships, neither partner was infected, in 21 percent there was one infected partner and in nine percent both partners were infected.
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Half of women and 41 percent of men correctly knew whether their partner had ever been tested.
Less than 30 percent of men and 38 percent of women correctly reported their partners' HIV status, and in most cases their partners were uninfected, according to the results in Sexually Transmitted Infections.
In half of relationships, both people said they did not know their partner's HIV status.
People who were married and both HIV-negative were most likely to be accurately informed about their partners' status. Men who were more satisfied in the relationship and women who accepted traditional gender roles were also more likely than others to know their partner's status.
"That was a curious issue for me since our work is about improving equality in gender roles, but it seems that women's acceptance and passivity were more aligned to greater knowledge," Wechsberg said.
"In Africa, social determinants and cultural/traditional gender roles have been part of the reason why more women have HIV," she said.
In this study, the women had very low rates of drug use and of having other sexual partners, but women usually have an early sexual debut with an older partner and are anatomically at greater risk for the infection, Wechsberg said.
"Research is needed to improve our understanding of how couples communicate about sexual health issues and to promote implementation of education and counseling strategies to facilitate more open communication," said Kendall J. Bryant, director of HIV/AIDS and Alcohol Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in Bethesda, Maryland, which funded the study.
Since this study was based in alcohol drinking settings, HIV information could be provided in bar settings through peers, servers and media in the venue, Bryant said. The findings also highlight the need to improve HIV testing uptake among men and to improve HIV disclosure among women in heterosexual partnerships.
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