Couples' counselling in Africa could cut HIV spread

Most transmission of the human immunodeficiency virus thatcauses AIDS in these countries is heterosexual, and theresearchers said it is mainly among married couples or peoplewho live together.

"To reduce HIV transmission, couples need to know theirjoint (HIV status) and have access to information which enablesthem to reduce the risk of infection both within and outsidethe union," Dr. Kristin Dunkle of Emory University in Atlantaand colleagues wrote in the journal Lancet.

"This is especially important for women, who might not havethe cultural freedom to negotiate condom use and sexualactivity within a union," they added.

Using a mathematical model based on existing data fromvoluntary HIV Counselling and testing in urban Zambia andRwanda, Dunkle and colleagues showed that 55 to 93 percent ofnew HIV infections among heterosexuals occur within couples whoare married or living together.

When they figured in the higher rates of condom use amongheterosexual partners not living together, the estimate of newinfections among married couples and those living together roseto 60 to 94 percent.

Next, they figured out how this transmission rate mightchange if the couples got HIV Counselling, using the resultsfrom a program in Zambia that reduced transmission amongcouples living together from 20 percent to 7 percent.

If applied more broadly, they believe a similar programcould cut transmission rates by 36 to 60 percent.

The researchers said most HIV prevention efforts in Africaare focused on abstinence and nonmarital sex, but theirfindings suggest investing in programs that focus on coupleswho are married or living together might have a significantimpact.

Sixty-eight percent of all people infected with HIV live insub-Saharan Africa, where 76 percent of all AIDS-related deathsoccurred in 2007. AIDS infects 33 million people globally andhas killed 25 million since the epidemic began in the 1980s.

(Editing by Maggie Fox and Eric Walsh)