Not so long ago, the media was awash with news of a woman who had been sentenced to death by the army after she killed her husband following a domestic dispute. Apparently, this young mother shot dead her husband after testing HIV positive and her husband negative. This was a discordant couple, where partners have different HIV test results. As testing together for HIV with one's partner becomes more common in Uganda, more and more couples discover that one partner is HIV positive while the other is HIV negative. This story is a clear indicator of our need to better understand what HIV discordance is, why it happens, how it is possible for partners to have different HIV statuses even after being together for several years, and how couples can deal with discordance in their relationship.

Giant Aids Ribbon. (Photo Courtesy Ofeibea Quist-Arcton/)

After counselling and testing, couples find out that they are both HIV negative, both HIV positive, and that one is HIV negative and the other is HIV positive (discordance). These discordant results are often the hardest for a couple to accept. The issue of discordance is still difficult for health workers to explain, yet it is a common occurrence in Uganda. The 2004/05 Uganda HIV/Aids Sero-Behavioural Survey showed that of all couples where at least one partner was infected with HIV, about half were HIV discordant. Couples may have different HIV test results even after being together for many years. This is because HIV is not transmitted every time an HIV positive person has sex with an HIV negative person. There are other factors that facilitate transmission of HIV, such factors may include presence of sexually transmitted infections (STIs), amounts of virus in the body (viral load) and not using condoms.

The important thing is that HIV can be transmitted to the uninfected partner at any time. Therefore, it is imperative that we empower discordant couples to prevent infecting the uninfected partner. In order to achieve this increased understanding and acceptance of discordance, our health workers need initial and refresher trainings in handling such cases. This will enable them give accurate information on discordance, thereby making couples understand and accept results and commit to positive living. There is also need to make sero- discordance a standard procedure in HIV/Aids facilitates; this will ensure that couples have special care and psycho social support as they often feel traumatised and experience feelings of guilt, fear, stigma, gender inequality and rejection.

Accepting and understanding HIV discordance, helps couples and the general community devise coping strategies such as healthy living and support groups. The government should also promote an environment where couples can discuss and address myths and disbeliefs associated with HIV discordance. This will foster understanding and mutual disclosure decisions. It is time we acknowledged that discordance is real and common.

Ms Mirembe works with the Health Communication Partnership