By VIOLET MENGO
JOEL Zimba and Miriam Bwalya are scheduled to get married and they are aware of the importance of couples’ voluntary counselling and testing (CVCT).
“If we go together for an HIV test, we get the results together and we will know the truth together right from the start,” says Mr Zimba, a 30-year-old man of Lusaka’s Kanyama Township.
Mr Zimba says testing as a couple is one way of showing love and commitment to each other.
He defines a couple as two people who are married, cohabiting, pre-marital partners contemplating marriage, sex partners or pre-sexual partners.
The couples say CVCT will help them discover their status and learn how best to respond to it.
Mr Zimba and Ms Bwalya say testing together helps couples to benefit from counselling sessions that aim to improve their communication.
Despite experts confirming that CVCT helps to reduce the risk of HIV transmission, less than one percent of African couples have been tested together.
This is a missed opportunity, since most pregnant women and people living with HIV are married or cohabiting.
It is against this background that the Rwanda -Zambia HIV Research Group (RZHRG) was established to provide CVCT in the two countries.
The research group started in 1986 in the Rwandan capital, Kigali, where it tested over 150, 000 couples. In Zambia, the project started in 1994 and currently has 71 CVCT government clinics.
In Rwanda, CVCT is now a standard of care and over 85 percent of pregnant women are tested with partners.
In Zambia, from 2007-2012, CVCT has been provided to over 10,000 couples per year in Lusaka and Southern Provinces while 48,000 couples were tested in 2010 alone.
Zambia Emory Research HIV Project national director William Kilembe explains that RZHRG provides CVCT follow-up services for discordant and concordant negative couples.
Discordant couples are those where one partner is HIV-positive and the other is not while concordant negative couples are couples that are HIV-negative.
“You can only know your partner when you know each other’s HIV status,” says Dr Kilembe.
Dr Kilembe says couples often will not test together because of conflicting work schedules or because they live great distances from each other due to work.
He says testing together as a couple eases the burden of disclosing results to partners.
“It is usually difficult to tell your partner your HIV status. But if they are counselled and tested together at the same time, and they are together when the results come, that added pressure is taken away,” Dr Kilembe says.
African couples represent the largest HIV risk group: more than two-thirds of new HIV infections are acquired from a spouse. HIV discordant couples represent the largest at risk group in Africa.
Studies of HIV-discordant heterosexual couples in Rwanda and Zambia show that when couples are counselled and tested together, the transmission of HIV from the positive to the negative partner is reduced from 20 to 25 percent.
The number of other sexually transmitted infections and unplanned pregnancies also decreases.
In 2009, RZHRG were designated Couples’ HIV Counselling and Testing Centres of Excellence by the U.S. Centres for Disease Control (CDC) in Zambia and Rwanda.
In this capacity, RZHRG provides training and technical assistance to help countries support and implement CVCT across a variety of settings, including increasing male involvement in PMTCT services.
The President’s Emergency Plan for AIDS Relief (PEPFAR) and CDC collaborated with RZHRG to develop the CVCT Intervention and Training Curriculum.
The curriculum has been used in CDC-led training in several African countries.
“We have trained over 1,785 people from 146 organisations in Botswana, China, the Democratic Republic of Congo, Ghana, Guyana and Haiti,” says director and founder of the RZH RG Dr Suzan Allen.
Other countries where training has been conducted are Ethiopia, Kenya, Malawi, Mozambique, Nigeria, Rwanda, South Africa, Swaziland, Tanzania, Uganda, the United States and Zambia.
RZHRG also assisted the World Health Organisation with its CVCT guidelines, which were published in April 2012.
These are called “Guidance on Couples’ HIV Testing and Counselling, including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples”.
The first CVCT Centre of Excellence workshops were convened in Kigali and Lusaka in 2009, and allowed participants to share best practices in improving uptake of CVCT.
The follow-up workshops took place from 29th November to 1st December in Lusaka and 5th to 7th December 2012 in Kigali, Rwanda, respectively.
The workshops allowed past recipients of Centre of Excellence technical assistance and training to share their experiences with countries who have not yet implemented CVCT.
It also provided a foundation to develop new training opportunities, a forum to discuss progress in centre of excellence countries, and an opportunity to identify challenges to CVCT roll-out and integration.
“Our research team has 15 years experience conducting heterosexual HIV prevention research in the capitals of two African countries,” says Dr Allen.
She says early studies in Rwanda showed that voluntary HIV counselling and testing results in pronounced risk reduction in married couples.
She says CVCT is the only prevention programme proven to reduce HIV incidence in the largest risk group the world over.
“Demand for couples’ VCT is low because of the belief that monogamy is ‘safe’, the fear of stigma, gender inequity between husband and wife, and lack of knowledge about where VCT can be obtained,” Dr Allen says.
Given the low demand, policy-makers and other influential groups need to take an active role in advocating CVCT.
Funding agencies also need to support VCT services so that supply and utilisation enhanced. It is critical that this continuing cycle of low demand low supply be interrupted.
Ministry of Community Development, Mother and Child Health permanent secretary Elwyn Chomba says testing only one partner in a couple does not result in decreased HIV risk.
Prof. Chomba says while it is important to know one’s own status, it is equally important to know one’s partner’s status. If both partners know both results, they know what they need to do and they are motivated to do it.
“Joint testing and counselling decreases transmission of HIV by more than 60 percent within discordant couples and reduces sexually transmitted infections and unplanned pregnancies in all couples,” she says.
CVCT is identified in the Zambia National AIDS strategy 2011-2015 as key prevention tool and an effective entry point for prevention services.
Despite CVCT being identified in the strategy, Prof Chomba says less than 10 percent of Zambian couples have been tested together to date.
“In urban Zambia, an estimated 70 percent of new HIV infections are in cohabiting partners who do not realise that one partner is HIV- positive and the other is HIV -negative,” Prof Chomba says.
She says two thirds of these can be prevented by couples going for voluntary HIV counselling and testing.
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