Ufrieda Ho, Spotlight
Love may be blind; but some things, you shouldn’t ignore – like knowing your and your partner’s HIV status.
South Africa is still considered the world epicentre of the HIV epidemic, with more than 7.1 million people living with HIV in 2016 and around 270 000 new infections that same year, according to Statistics South Africa.
However, as more people gain access to support and improved treatment options for their HIV infection, so they come to live full, healthy lives. They’re also inevitably involved in relationships with people who are not infected with HIV. These mixed HIV-status relationships, where one person is HIV-positive and one is HIV-negative, are called serodiscordant or mixed-serostatus relationships.
Serodiscordant relationships have become part of the ‘new normal’ of our range of relationships. They deserve the right kind of medical advice, management and support to ensure that these sexual relationships don’t come with the risk of HIV transmission.
Researchers join the dots between low knowledge of HIV status and increased risk of transmission between partners. In 2014, Wits RHI researcher Catherine Martin found that up to half of the number of HIV-infected people in her sample group were involved with an HIV-negative partner. Despite this, she found that knowledge of status results was low, with 52.6% of women knowing their status, while only 37.5% of men knew their status.
It makes knowing your status the first step to take in any new sexual relationship. Developing open communication and trust with your partner or partners is also essential. Next, clinicians promote a multi-pronged strategy to manage mixed-serostatus relationships. This entails counselling and good medical advice as a foundation.
Clinicians advocate the ‘Treatment as Prevention’ route. This means that regardless of CD4 count, the HIV-positive partner or partners should start ART as soon as possible after diagnosis. A 2011 study called HPTN 052 found this intervention approach to be 96% effective in reducing transmission of the virus, as viral load can be reduced to be undetectable. Subsequent studies have confirmed that if someone has an undetectable viral load, they are not infectious.
Starting ART as early as possible is not just good for preventing onward transmission of the virus; it is also good for the health of people living with HIV. In 2016, the landmark START trial showed that people who started taking ART earlier were less likely to get tuberculosis or various forms of cancer.
Other critical strategies to manage the sexual relationships of serodiscordant couples and multiple-partner sexual relationships include the use of condoms during sex, as well as undergoing medical male circumcision.
Added to this is the emergence in recent years of pre-exposure prophylaxis (PrEP). PrEP involves people who do not have HIV taking a pill to prevent acquiring HIV. Current PrEP consists of taking a daily pill containing two antiretrovirals: tenofovir and emtricitabine.
It’s also a regime that’s regarded as an appropriate treatment intervention for heterosexual serodiscordant couples who want to conceive naturally. Jennifer Power, a research fellow at the Australian Research Centre for Sex, Health and Society at La Trobe University, writing in The Conversation in April 2015, says that PrEP “re-introduces the possibility of ‘safe’ sex without condoms”, and “allows natural conception with minimal risk. Evidence to date supports the safety and efficacy of PrEP for serodiscordant couples trying to conceive, and it’s seen as a sensible choice”.
The World Health Organisation (WHO) recommendations for serodiscordant couples who want to fall pregnant include ART to suppress viral load; the use of PrEP by the non-infected partner; sexual intercourse without condom use when the woman is at peak fertility; screening and treatment of sexually transmitted infections in both partners; and voluntary medical male circumcision.
It is noteworthy that the WHO acknowledges that serodiscordant couples who would like to have children are “often inadequately supported or face significant barriers to accessing existing sexual and reproductive health services”.
This speaks to the need to challenge stigmas and old societal norms among the general public, as well as among healthcare workers. And along with changing attitudes and behavioural practices, there must also be appropriate policies, legislation, funding, proper implementation and oversight.
This means many layers of responsibility and action coming together for better solutions to minimising the HIV risk for more serodiscondant relationships. It also makes loving whoever you choose that little bit easier to do.
Leonora Mathe, Treatment Action Campaign
Bonolo (not her real name) was born on 22 September 1987 in Cosmo City, in Johannesburg. She became HIV-positive at birth, and started taking ARVs at the age of 10.
“After matriculating from high school, I had my first boyfriend, who I loved so much; sadly, I lost him as soon as I disclosed my status. He blamed me for wanting to infect him. I was very hurt, because being HIV-positive is not a wrong choice I made; I was born with it.
“Actually, it made me lose my confidence and have low self-esteem, in such a way that I doubted I would ever find an intimate partner again who would love me as I am; but things changed when I met my husband of five years.
“We went out for our first and second dates, and as soon as the relationship started getting serious, I told him I was HIV-positive, and asked if he knew about his status. He took a break from the relationship, because he was scared and confused; but after he consulted clinicians and social workers, they taught him more about HIV. We reunited after six months, and we are married now.
“I would love to have children; and although studies have shown that you can have HIV-free children, I always fear that… what if something goes wrong? But my husband assures me that all will be well, and we should consider trying for one soon.”