HIV Sero-Discordant Couples in Southwest Nigeria: Prevalence and Associated Risk Factors

Abstract

This is a cross-sectional multicenter study to determine the prevalence of HIV sero- discordancy and the associated factors. A total of 166 respondents had questionnaire-based interview. All the respondents were PLHIV and most (87%) have been in heterosexual relationship for at least one year. 13% (n=21) were male and 87% (n=145) were female and more than half of them (57%) have been living with HIV for more than a year. Their modal CD4 count was 350-500 cell/mm3 and 93% of them were on ART. About 93% (n=154) had no prior knowledge of their HIV status before starting the index sexual relationship, hence it is difficult to say if there were infected in the course of the present relationship. Opportunistic infection was present in 31% while 69% do not have any opportunistic infection. Co-infection with STI was present in 7% and almost 93% had no such infection. Up to 58% (n=96) of the respondents have HIV negative partners (discordant couples), 40% (n=66) have HIV positive partners (concordant partners) and 2% (n=4) do not know their partners' HIV status. 96% of the study participants use contraceptive with condom being the commonest (95%). But only half (56%) have disclosed their sero-status to their partners. All the male partners are circumcised. Most partners (79%) have repeated their HIV test to monitor their sero-status. The prevalence of sero-discordant couples calculated in this study is similar to what has been found in other African countries. Respondents with sero-discordant partners are more likely to have either primary (18.75% vs 16.67%) or tertiary ( 32.29% vs 22.73%) education as the highest level of qualification, more likely to be in the age bracket 31-40yrs (43.75% vs 10.61%), more likely to be unemployed ( 25 vs 19.7), more likely to know their own HIV status before starting the index relationship and less likely to disclose their HIV status to their partners (58.33% vs 21.21%) while those with sero-concordant partners have more secondary education (60.0% vs 48.96%), more likely to have longer duration (date of HIV diagnosis) of HIV infection, more predisposed to opportunistic infections (46.96% vs 19.79%), more likely to have repeated HIV test for their sexual partners (98.48% vs 68.75%), more likely to have been in sexual relationship for 3years. No significant difference in the religious affiliations, use of ARV by the positive partners and condom use between the two groups. The hausa tribe has more sero-concordant relationship (7.58% vs 3.1%) while the other two major tribes (Yoruba and Igbo) have equal distribution of both sero-statuses. The low rate of status disclosure among partners is a cause for concern and may promote transmission, even though the rate of use of the prevention combination (ART,Condom and Circumcision) is high enough to mitigate such risks.