In-depth: Beyond ABC: The challenge of Prevention
AFRICA: Testing helps avoid infection
Photo: IRIN
Testing motivated women to talk to their partners about HIV
JOHANNESBURG, 14 November 2005 (IRIN In-Depth) - Being tested for HIV, regardless of the result, helps women start a dialogue to protect themselves and their partners from infection, according to a new study.
French researchers conducted the "Ditrame Plus 3" study in Cote d'Ivoire to examine HIV risk management within couples and identify the factors that help or hinder the adoption of preventative behaviour.
"We wanted to study behaviour patterns that were traditionally considered low-risk because they occurred within a stable relationship," Annabel Desgrees du Lou, one of the study's co-authors, told PlusNews. "So we looked into things like the role of monogamous vs. polygamous marriages, whether or not the partners lived together, the degree of communication between them and the preventative measures taken by the couple."
The project started in 1995 and focused on pregnant women undergoing prenatal care in two working-class neighbourhoods of Cote d'Ivoire's economic capital, Abidjan. An HIV test was proposed to each of the women during the course of their medical consultations.
Of those who met the study's requirement of having a regular partner, 322 tested positive and 353 tested negative.
Over the course of the next 18 months, the researchers observed the women to see if they spoke to their partners about HIV/AIDS, informed them of their test results, encouraged them to get tested, and whether the couples took preventative measures against HIV infection.
TESTING LEADS TO DIALOGUE
The results of the study varied according to the type of relationship, religion, education level and relative ages of the partners, and whether or not they lived together; but in all cases, discussion of HIV and sexually transmitted infections (STIs) increased after testing.
While less than half the women reported having discussed STIs or HIV/AIDS with their partners before their test, 96 percent of those who tested negative and 66 percent of those who tested positive subsequently initiated dialogue.
"It's clear that HIV testing in the context of prenatal care stimulates communication on STIs and HIV/AIDS within couples," said Desgrees du Lou. "It's a good way to reach Mr and Mrs John Q. Public."
"Testing is a lot more productive than HIV awareness campaigns," added Hermann Brou, another of the study's co-authors.
Polygamy was one factor with a negative impact on establishing dialogue, and more so if the couple did not live together.
"There was more discussion within polygamous couples staying under the same roof compared to [monogamous couples] living separately," said Desgrees de Lou.
ENCOURAGING PARTNERS
More than nine HIV-negative women out of 10 told their partners their results and encouraged them to be tested - advice that was followed only 17 percent of the time.
Only half the HIV-positive women informed their partners of their status, but nearly 70 percent suggested they go for a test; only 22 percent of the men, mostly from monogamous couples, did so.
Regardless of their test results, many women who were reluctant to talk directly about HIV used more creative methods to raise the subject, especially regarding prevention.
"Some women seized on domestic squabbles over extramarital affairs to ask their partners to use a condom 'at least'," said Brou. "Others brought it up as a joke, advising to 'cover up if you're going out'."
If it was relatively easy for women to ask their partners to use a condom for extramarital relations, it was much harder to suggest preventative measures within their own relationship.
When couples resumed having sex after the birth, 30 percent of those in which the woman was HIV-positive used condoms systematically. This figure rose to 50 percent if the partner had also been tested. Only 25 percent of couples with an HIV-negative woman used condoms.
According to the study, communication and the partner's level of education were the factors that affected condom use when the woman had tested positive. When the results were negative, only the woman's level of education had an impact.
TARGETING THE COUPLE
According to Brou, all the women invoked contraception to persuade their partners to use condoms. Among those unable or unwilling to demand condom use, some resorted once again to indirect ways of protecting themselves or their partners from HIV infection.
In the majority of cases, the women extended the period of abstinence after giving birth to an average of 17 to 21 weeks, depending on their test results.
Women who did not live with their partners, or who were in a polygamous marriage, had less trouble getting this extension accepted. On average they lengthened the post-partum period of abstinence to 61 weeks and 37 weeks respectively.
While the study found that testing motivated women to talk to their partners about HIV and take steps to protect themselves better, the men were generally unwilling to be tested or use protection.
In the future it will be necessary to target the men as well, especially in polygamous unions where, "only the man knows the kind of relations he has with each of his wives and it is, therefore, up to him to be aware of how to prevent infection," said Desgrees de Lou.
"An HIV-testing policy targeting couples, while taking into account the particular needs of both partners in their specific relationship, could help to overcome these obstacles," Brou commented. "That way, the woman won't have to bear all the responsibility for making the couple aware of the risks of HIV."