Are Americans Ready for Couples' HIV Counseling?

Couples’ voluntary HIV counseling and testing is commonly known as CHTC in the United States, but also is called CVCT in other parts of the world. It is an evidence-based risk reduction intervention practiced mostly in high prevalence settings in Africa, but not widely in the United States.

In 2012, the World Health Organization recommended that CHTC should be offered to all couples regardless of serostatus or gender, citing its potential benefit to promote health services and antiretroviral therapy (ART) for serodiscordant couples.

According to research published in The Open AIDS Journal, CHTC engages couples with “HIV testing, facilitated serostatus disclosure and HIV prevention counseling with discussion of sexual agreements, condom use, and linkage to care.”

In March 2014, investigators conducted a study of 64 HIV-positive patients recruited from Emory Midtown Infectious Disease Clinic in Atlanta and 33 of their main partners to find out if they would be willing to participate in CHTC and what aspects of the intervention were of most interest to them.

Researchers found that most respondents, especially those with negative or unknown HIV status, were likely to participate in CHTC, and they had many of the same interests in common.

Characteristics of Respondents and Potential CHTC Benefits

Most of the HIV-positive respondents were men (89%) on antiretroviral therapy ART (92%), and many were self-reported homosexuals (62%). A majority of HIV-positive study participants who reported having a main partner (67%) were in relationships longer than 12 months. Nearly all (97%) had disclosed their HIV status to their partner.

Of the 15 HIV-negative partners interviewed, all were men, most identified as homosexual (73%), and 54% reported consistent condom use with their HIV-infected partners.

Researchers observed “a high prevalence of serodiscordance among HIV-infected persons with primary sexual partners.” This supported their belief that CHTC can be a high-impact strategy to “identify discordant couples and reduce risk behaviors among these couples, where the majority of HIV transmissions occur.”

CHTC Interest Among Serodiscordant Couples

It was somewhat surprising for investigators to find that most respondents felt they had self-disclosure of HIV status under control, without counseling. Among HIV-positive participants, 36% were unwilling to participate in CHTC, with the reasons most cited being a perceived lack of need (26%) and a desire to self-disclose their status (26%).

Willingness to participate in CHTC was highest among partners with negative or unknown HIV status (87%). Topics they were most interested to discuss in CHTC were ART (47%), other sexually transmitted infections (STIs) (47%), mental health services (40%), and relationship agreements like sexual monogamy (33%). Most (93%) believed their HIV-positive partners were virally suppressed, but in the event they were not, most (73%) were willing to take pre-exposure prophylaxis (PrEP).

Primary interests were consistent among HIV-positive respondents, with the exception of mental health services. Topics most interesting to HIV-positive willing participants in CHTC were ART (48%), other STIs (44%), and relationship agreements (31%).

Interestingly, of the 23 HIV-positive respondents who indicated they were unlikely or didn’t know if they would participate in CHTC, 17% cited fear of disclosing sensitive information in front of their partner as a reason.

Authors said this is a useful lesson for practitioners trying to implement CHTC in the United States. Educational and promotional materials should dispel myths by stressing that “CHTC focuses on future relationship goals and expectations rather than asking participants to have potentially uncomfortable discussions about past behavior.”

The cumulative probability of transmitting HIV infection over a 10-year period is 13% in heterosexual couples and 76% in homosexual couples when relying on condoms alone, the report said. For all of these reasons, authors concluded that “regular CHTC could be an important component in sustaining risk reduction practices in serodiscordant couples.”