What is a discordant couple?

A number of couples turn out to have different HIV test results, one partner being HIV negative while the other is HIV positive.

Kenya AIDS Indicator Survey showed that 44% of married/cohabiting HIV-infected persons had an HIV uninfected partner.
It is very confusing to the couple due to the many dilemmas and unanswered questions.

Outcomes that occur:

  • Infection of the non-infected spouse
  • Re-infection for both of them
  • Abandonment of the positive partner especially in case of dependence, e.g. a housewife who is dependent on her husband

How does HIV get in the family?  Whose responsibility is it to protect the other in this family?  How far will the uninfected remain loyal to the partner in terms of care and support?

It is more likely that the large proportion of discordant couples is due to the fact that once the first partner is infected; this does not automatically imply that the other partner will be infected rapidly.  Quinn and others (2000) estimate in the Rakai study in Uganda, that the HIV incidence rate among 415 initially HIV negative partners was 11.8% 100 person years.  At that rate, it takes several years for a discordant couple to become concordant positive.  This rate per person year depends on the frequency of sexual intercourse.

Prevention among discordant couples

There is a scope for prevention among couples, even though it is rarely mentioned as a priority in prevention efforts.  These are:

·        Knowing your status early before marriage/getting into a relationship

·        Ensure you test three months after the first HIV negative test.  During this period practice safer sex (use condoms properly)

·        Once the second HIV test is still negative, use a condom to avoid re-infecting your partner

  • Consult a doctor if you are planning to have a baby. Prevention of mother to child transmission is important. At present in vitro fertilization is the safest way for an HIV-positive woman and HIV-negative man to conceive a child.  If that is not available or feasible, other options could be considered.  They would include driving your HIV plasma viral load down to undetectable levels with antiretroviral drugs that can safely be used during pregnancy and possibly having your husband use antiretrovirals as well.  This would be considered a form of PrEP (Pre-exposusure prophylaxis)
  • Join a discordant couples’ support group where challenges and experiences may be shared.
  • See a counsellor to enable you address your fears and challenges such as disclosure issues