Persons in steady sexual relationships

Persons in steady sexual relationships
A high proportion of HIV transmission takes place between steady partners. Therefore,
not using condoms or using them inconsistently can be a problem. This is particularly
true in settings with high HIV prevalence, where the likelihood that a partner may be
infected is raised।
There are barriers, of course, to using condoms with steady partners or in stable
relationships. Trust, power inequalities, and the desire for children are common issues
among married couples which can discourage condom use 21. Studies in Kenya and
Zambia show that, while marriage increases the frequency of sex, it decreases condom
use and can severely restrict women’s ability to protect themselves from infection. The
association of condom use with casual or commercial sex persists as a barrier because
it reinforces the misperception that protection against STIs or HIV is not needed with
regular sexual partners. However, there is growing evidence in many countries of the
risk of HIV infection within marriage. In a recent study in India, 90% of women being
treated for STIs had only one lifetime partner, and 14% were HIV-positive. In Kisumu,
Kenya and Ndola, Zambia, adolescent married girls age 15–19 years were found to
have higher levels of HIV infection than non-married sexually active girls the same age,
demonstrating that not only is marriage not protective in some settings, but it actually
can increase risk22.
It would seem to be rational behaviour for HIV-serodiscordant couples to use condoms.
However, most studies of serodiscordant couples reveal low condom use: 17% reported
regular condom use in Rwanda23, 24% in Haiti24, and 33% in Zambia25. Condom use has
been reported to be more frequent in HIV-serodiscordant couples where the woman is
the HIV-positive partner than in relationships where the man is HIV-positive