Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach
These guidelines recommend increasing the offering of HIV testing and counselling (HTC) to couples and partners, with support for mutual disclosure. They also recommend offering antiretroviral therapy (ART) for HIV prevention in serodiscordant couples.
In most sub-Saharan African countries with generalized HIV epidemics, three-quarters of adults ages 20–49 years report being in cohabiting relationships. Among people with HIV who are in stable relationships, up to half have an HIV-negative partner—that is, they are in a serodiscordant relationship (one partner is HIV-positive, the other is HIV-negative).
In most studies of serodiscordant relationships, half of the infected partners are male and half are female. In regions other than Africa, HIV epidemics are for the most part concentrated and primarily affect three highly vulnerable key populations: men who have sex with men (MSM), injecting drug users (IDU) and sex workers. Countries with generalized epidemics also frequently have significant epidemics among key populations as well as in the general population. These epidemics are often not fully recognized, and services for key populations in generalized epidemics are often not adequately prioritized.
Although these guidelines will have greatest relevance in generalized epidemics, where most transmission is through heterosexual sex, they could also be adapted for other regions, as many people in key populations will be in cohabiting relationships, and those with HIV may have similar rates of serodiscordance with their partners as in generalized epidemics.