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Researchers set out to determine the proportion of HIV transmission that occurs in cohabiting heterosexual partners. The share of the burden between couples verses single individuals has been a debated topic and they wanted to try to get closer to to the truth. What did they find?
In surveyed couples, we estimated that extra-couple transmission accounted for 27—61% of all HIV infections in men and 21—51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32—65% of new incident HIV infections in men in cohabiting couples, and 10—47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation.
That means that somewhere near half of HIV infections occur in people who are living with a partner. This data means that HIV prevention work should target people who are single and in relationships. The Economist adds more context:
One of the problems of dealing with a sexually transmitted disease, such as AIDS, is that people routinely lie about their indulgence in the sorts of behaviours which pass it on. That makes knowing where to put your effort harder than it need be. And in no area do people lie more than on the question of infidelity. The naive outsider might be forgiven for thinking that infidelity was likely to be an important way that HIV, the virus which causes AIDS, is spread. Until now, however, that was mere supposition.
Early in the AIDS epidemic, the virus was spread by what might be termed “long-distance” infidelity. Lorry drivers and migrant miners, lonely and far from home, were the vectors. Those groups, however, could be made the target of campaigns designed to ask them to think about what they were up to, and to be more careful about it. What Dr Bellan has uncovered looks more quotidian—and thus much harder to deal with.
PSI uses behavior change communications to target concurrent sexual partners(aka people in relationships who carry on with outside partners). In Kenya, PSI launched a national mass media campaign to increase risk perception among married men and women. PSI Zimbabwe is currently implementing IPC led interventions to facilitate community discussions about risk perception and is preparing to launch a new, national campaign. In Mozambique, PSI has developed interactive tools used by outreach workers to facilitate participatory discussions and critical thinking about Concurrent Sexual Partnerships (CSP) among community members. In Botswana, PSI provides support to the Botswana government to design and implement a national multi-channel campaign to raise awareness and risk perception about CSP and to encourage partner reduction.
A campaign launched in Uganda called ”Go Red for Fidelity” encouraged people in long term relationships or marriages to stay faithful to each other. A host of communications were employed ranging from billboard ads to text messages. A ‘love wheel’ was introduced in 2011 that sought to bolster relationships. IRIN reported on its release:
Spin the wheel and get a tip to spoil your better half; spend more time together or go out for a romantic evening: A new Ugandan HIV prevention programme hopes a “love wheel” will encourage couples to seek excitement within their own marriages rather than in the arms outsiders.
Reenah Kakuru has already noticed the difference the “love wheel” is making in her marriage. “Today he gave me money to spoil myself. Sometime back his ‘love wheel’ task was to call some of my friends over [to visit] and I could see him struggling because he was supposed to pick the best three among many and he did not know who they were,” she told IRIN/PlusNews.
“The greatest thing about it is that at the end of the day there is something to look forward to,” she added.
“It has a playful element in it, improves intimacy, builds relationship with family, friends and boosts creativity,” said Reenah’s husband Peter. “We have very demanding jobs that sometimes keep you very busy and you forget – but this is a relationship reminder that keeps you together as a couple.”
The wheel, categorized into eight thematic areas such as family, fitness, fun, friends and finances, has a number of tips relating to each theme. Currently stocked in supermarkets in the capital, Kampala, its promoters say they have sold more than 1,500 units since its launch in November 2010.
“We did not have a fidelity option for people who wanted to remain faithful but did not know how to do it,” said Julius Lukwago, marketing and communications director for social marketing NGO Programme for Accessible Health, Communication and Education (PACE). “A strong marriage like everything else in life – education, career – needs to be worked on.”