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Couples-based Intervention May Limit HIV Transmission in African Countries

Science Update

A shift to a couples-based intervention for married and cohabiting couples in urban Zambia and Rwanda could prevent up to 60 percent of new HIV infections that would otherwise occur, according to an NIMH-funded study published June 27, 2008, in The Lancet.

Kristin Dunkle, Ph.D. and Susan Allen, M.D., both of Emory University, and colleagues examined data on Zambian and Rwandan sexual behavior and service use collected as part of an Africa-wide demographic and health survey (DHS).  The data included responses from 1,739 Zambian women, 540 Zambian men, 1,176 Rwandan women and 606 Rwandan men. The survey found that 45 to 75 percent of HIV-positive married individuals in Africa have HIV-negative spouses. Dunkle and colleagues estimate that 55 to 93 percent of new heterosexual HIV infections occur within marriages or cohabiting relationships.

Previous studies have estimated an HIV transmission rate of 20-25 percent per year among married and cohabiting couples in urban Zambia and Rwanda, regardless of which spouse has the infection. Other studies have found that among couples who have received couples-based voluntary counseling and testing (CVCT) in other parts of Africa, however, the transmission rate is about 7 percent or less per year. If a CVCT intervention is adopted in Zambia and Rwanda, 36 to 60 percent of HIV infections could be averted, the researchers estimate.

Currently, most intervention programs target individuals only. But the majority of Africans at risk of HIV are married or cohabitating. This study supports the notion that an intervention aimed at couples may be more effective in preventing or reducing HIV transmission. In addition, services to HIV-positive individuals should be expanded to include spouses, the researchers conclude.

Dunkle and colleagues strongly encourage other researchers to conduct similar studies in other settings to refine estimates of the proportion of HIV infection that occurs within marriages, and learn more about how spouses are involved in HIV transmission.


Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, Greenberg L, Allen S. Estimating the proportion of new heterosexually transmitted HIV infections that occur within married/cohabiting couples in urban Zambia and Rwanda. The Lancet. 27 June 2008. 371(9631):2183-2191.