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Most Heterosexual HIV Spread in Africa Within Couples

Voluntary counseling or testing for couples may be needed

FRIDAY, June 27 (HealthDay News) -- More than half of heterosexually acquired HIV transmission in urban Zambia and Rwanda occurs within married or cohabitating couples, suggesting that voluntary counseling or testing for couples is needed, according to a report in the June 28 issue of The Lancet.

Kristin L. Dunkle, Ph.D., from Emory University in Atlanta, and colleagues estimated the extent of heterosexual HIV transmission within married or cohabitating couples in Lusaka in Zambia and Kigali in Rwanda, using data on HIV serostatus from a voluntary counseling and testing service for couples, and surveys of heterosexual behavior in Zambia in 2001-2002 and Rwanda in 2005. Data was analyzed for 1,739 Zambian women, 540 Zambian men, 1,176 Rwandan women and 606 Rwandan men.

The researchers estimated that 55.1 to 92.7 percent of new heterosexually acquired HIV infections occurred within couples, depending on location and the sex of the infected partner. A model incorporating the higher rate of condom use among non-cohabitating partners increased the estimate to 60.3 to 94.2 percent. Reducing transmission from 20 percent to 7 percent every year could avoid 35.7 to 60.3 percent of infections that would otherwise occur, the authors estimate.

"Since most heterosexual HIV transmission for both men and women in urban Zambia and Rwanda takes place within marriage or cohabitation, voluntary counseling and testing for couples should be promoted, as should other evidence-based interventions that target heterosexual couples," Dunkle and colleagues conclude.

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