Voluntary counselling and testing for couples is an important HIV

Voluntary counselling and testing for couples is an important HIV-prevention effort in sub-Saharan Africa where a substantial proportion of HIV transmission occurs within stable partnerships. This study aimed to determine the acceptance and effectiveness of couples voluntary counselling and testing as compared to individual voluntary counselling and testing. 1,521 women attending three antenatal clinics in Dar es Salaam were randomized to receive individual voluntary counsellingduring that visit or couples voluntary counselling with their husbandsat a subsequent visit. The proportion of women receiving test results in the couples voluntary counselling and testing arm was significantly lower than in the individual voluntary counselling and testing arm (39 vs. 71%). HIV prevalence overall was 10%. In a subgroup analysis of HIV-positive women, those who received couples voluntary counselling and testing were more likely to use preventive measures against transmission (90 vs. 60%) and to receive nevirapine for themselves (55 vs. 24%) and their infants (55 vs. 22%) as compared to women randomized to individual voluntary counselling and testing. Uptake of couples voluntary counselling and testing is low in the antenatal clinic setting. Community mobilization and couple-friendly clinics are needed to promote couples voluntary counselling and testing.

In this study, only 16% of the women randomised to the couples voluntary counselling and testing arm were counselled, tested, and shared results together with their husbands/cohabiting partners. This is an opportunity to learn together about HIV transmission, discuss personal and combined risks, and develop a collaborative plan to prevent further transmission, assisted by a professional. Antenatal clinics are clearly either not perceived by men as male-friendly places or not perceived by couples as couple-friendly places. Given that a considerable proportion of HIV transmission in sub-Saharan Africa is occurring within married or cohabiting couples and given that individual testing and counselling addresses only half of the sexual partnership, strategies to create new social norms to increase the acceptability of couple testing and determine the best venues for it are urgently needed.