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).
They have plans of having children and a life-
long partnership, hence an HIV test is key to their plans.
“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.