10 October 2010

Uganda: We Need to Help Couples Understand HIV Discordance

Photo: Ofeibea Quist-Arcton/
Giant Aids Ribbon.


Kampala — NOT so long ago, the media was awash with news of Judith Koriang, a woman who had been sentenced to death by the Court Martial after she killed her husband following a domestic dispute.

Apparently this young mother shot dead her husband after he tormented her for being HIV-positive, yet he was negative. This was a discordant couple, where partners have different HIV test results.

As testing together (as a couple) for HIV becomes more common in Uganda, more and more couples are finding that one partner is positive while the other is negative. Koriang's story is a clear indicator of our need to better understand what HIV discordance is, and how couples can deal with it in their relationship.

Discordant results are often the hardest to accept among couples. It is also difficult for health workers to explain, yet it is common 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. Just like when you may or may not get sick after being around someone with flu. Other factors that facilitate transmission of HIV may include presence of sexually transmitted infections, amount of virus in the body and not using condoms.

The important thing is that HIV can be transmitted to the uninfected partner at any time. Discordant couples need to be empowered to prevent infecting the uninfected partner. If the couple continues to have unprotected sex, the HIV-negative partner is at a very high risk of infection.

In order to achieve this increased understanding and acceptance of discordance, our health workers need to be trained on how to carry out quality couple HIV counselling and testing, and also refer clients to where they can access treatment, care and support services.

They need to be trained on how to handle discordant results. This will facilitate them to give accurate information on discordance, there by making couples understand and accept results and commit to positive living. They need to explain discordance in simple terms to avoid domestic violence among discordant couples.

There is also need to make sero-discordance a standard procedure in HIV/AIDS facilities. 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. Health workers should understand couples' specific history and experiences.

Accepting and understanding HIV discordance helps couples and the general community to devise coping strategies such as health living and support groups. The Government should promote an environment where couples can discuss and address myths and disbeliefs associated with HIV discordance. This will foster understanding and mutual disclosure decisions.

The writer works with the Health Communication Partnership

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