An interesting phenomenon in the HIV epidemic is that among African couples where at least one member is infected with HIV, in nearly two thirds of the cases only one member is actually infected – that is that there is a very high prevalence of “serodiscordance”. Serodiscordance can happen when transmission has not yet occurred between new couples or in a stable relationship when one partner acquires the virus elsewhere an introduces it into the relationship (for example if one member is cheating). Transmission of virus within existing couples is an important source of new infections and therefore prevention messages must still be targeted towards married or other stable couples. It is also part of the appeal of the “concurrency” hypothesis as a dominant mode of HIV transmission.
The stereotypical view of this situation is that African men are ones that introduce HIV into relationships – they are the ones that engage in extra-marital relationships, they are the ones that hire prostitutes, they are polygamous, they have more power in sexual relationships, etc – in short, they are dogs [exaggeration added]. A new study, which includes both a meta-analysis as well as secondary analysis using population based DHS data, sugests that this stereotype may not be justified – that women might be as likely to be the “index case” as men.
Oghenowede Eyawo and co-authors find:
The proportion of HIV-positive women in stable heterosexual serodiscordant relationships was 47% (95% CI 43–52), which shows that women are as likely as men to be the index partner in a discordant couple. DHS data (46%, 41–51) and our sensitivity analysis (47%, 43–52) showed similar findings.
Of course there might be biases that occur outside of relationship formation that might lead to more gender balance in more stable relationship vs. other forms of relationships that we might also care about. But the findings of this study are very interesting from a policy perspective because much HIV programming focuses more on men as index case than women and if this is not true than additional efforts must also be directed at women as well.Share on Facebook