Knowledge of HIV Serodiscordance, Transmission, and Prevention among Couples in Durban, South Africa.

• Type of Material: Article
• Authors: William Kilembe, Emory University; Kristin Wall, Emory University; Susan Allen, Emory University; Mammekwa Mokgoro, University of KwaZulu-Natal; Annie Mwaanga, Emory University; Elisabeth Dissen, Emory University; Miriam Kamusoko, University of KwaZulu-Nata; Hilda Phiri, Emory University; Jean Sakulanda, Emory University; Jonathan Davitte, Emory University; Tarylee Reddy, Medical Research Council; Mark Brockman, Simon Fraser University; Thumbi Ndung'u, University of KwaZulu-Natal
• Language: English
• Date: 2015
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Kilembe et al.
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0124548
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 10
• Issue: 4
• Start Page: e0124548
• End Page: e0124548
• Grant/Funding Information: Emory Center for AIDS Research (P30 AI050409); Canadian Global Health Research Initiative (GHRI) International Development Research Centre (Project Number: 107017‐001); AIDS International Training and Research Program Fogarty International Center (D43 TW001042).
• Research Categories: Health Sciences, Public Health; Biology, Virology

Abstract

Objective Couples’ voluntary HIV counseling and testing (CVCT) significantly decreases HIV transmission within couples, the largest risk group in sub-Saharan Africa, but it is not currently offered in most HIV testing facilities. To roll out such an intervention, understanding locale-specific knowledge barriers is critical. In this study, we measured knowledge of HIV serodiscordance, transmission, and prevention before and after receipt of CVCT services in Durban. Design Pre- and post-CVCT knowledge surveys were administered to a selection of individuals seeking CVCT services. Methods Changes in knowledge scores were assessed with McNemar Chi-square tests for balanced data and generalized estimating equation methods for unbalanced data. Results The survey included 317 heterosexual black couples (634 individuals) who were primarily Zulu (87%), unemployed (47%), and had at least a secondary level education (78%). 28% of couples proved to be discordant. Only 30% of individuals thought serodiscordance between couples was possible pre‐CVCT compared to 95% post-CVCT. One-third thought there was at least one benefit of CVCT pre‐CVCT, increasing to 96% post‐CVCT. Overall, there were positive changes in knowledge about HIV transmission and prevention. However, many respondents thought all HIV positive mothers give birth to babies with AIDS (64% pre-CVCT, 59% post-CVCT) and that male circumcision does not protect negative men against HIV (70% pre-CVCT, 67% post-CVCT). Conclusions CVCT was well received and was followed by improvements in understanding of discordance, the benefits of joint testing, and HIV transmission. Country-level health messaging would benefit from targeting gaps in knowledge about serodiscordance, vertical transmission, and male circumcision.