Couples Voluntary Counseling and Testing: An Effective Prevention Strategy

OCTOBER 2009 — The majority of new HIV infections in Africa are acquired from a spouse. HIV-discordant couples, where one partner is HIV-positive and the other is HIV-negative, represent the largest at-risk group in Africa. Studies of HIV-discordant, heterosexual couples in Rwanda show that when couples are counseled and tested together, the transmission of HIV from the positive to the negative partner is reduced from 20 to 25 percent to 3 to 7 percent per year. The number of other sexually transmitted infections and unplanned pregnancies also decreases.

Based on this evidence, FHI is collaborating with Projet San Francisco (PSF), a local HIV research organization with long experience implementing couples voluntary counseling and testing (CVCT). PSF will help institutionalize CVCT it as a standard of care at 28 FHI-supported health facilities in four districts of Rwanda. PSF's support to these sites includes three days of classroom training for health facility staff, FHI staff, and district supervisors, followed by practical training.

Through CVCT, couples discover their HIV status together and learn how best to respond. Discordant couples learn how to prevent transmission of HIV within their marriage through educational sessions on preventative behaviors, use of condoms, and other family planning methods. Couples also benefit from counseling sessions that aim to improve their communication. Finally, HIV-infected partners identified through CVCT services are referred for evaluation and enrollment into care and treatment programs.

Despite over a decade of research confirming that CVCT helps to reduce the risk of HIV transmission, less than 1 percent of African couples have been tested together. This is a missed opportunity, since most pregnant women and patients with HIV are married or cohabiting. Health professionals should promote CVCT in Africa and encourage couples to get tested together. This new program is an important step in that direction.

PHOTO: A couple receives counseling and testing services (FHI/Rwanda)

Related Resources
HIV Counseling and Testing (topic page and resources)

Strategies for Successful HIV Counseling and Testing Services (FHI/Malawi success story)