In the HIV/AIDS arena, theÂ idea of “treatment as prevention” has been gaining strength. Multiple studies have shown that treatment with anti-retroviral drugs can dramatically reduceÂ the likelihood that someone infected with HIV will be able to pass the virus to someone else.
However, a recentÂ strategy documentÂ for HIV/AIDS prevention developed byÂ aÂ International Antiviral Societyâ€“USAÂ panel, co-led by Rollins Global Health chair Carlos Del Rio, puts biomedical interventions hand in hand with psychosocial measures such as couples counseling and treatment for drug dependence.
Why? Because people everywhere can have trouble sticking to antiretroviralÂ treatment, even if drugs are available. And couples counseling by itself is valuable.
A powerful example of how this plays out, and of the importance of couples counseling to the effectiveness of antiretroviral drugs in prevention, comes fromÂ a recent presentation fromÂ Emory epidemiologist Kristin Wall at the AIDS 2014 meeting in Australia. The website NAM AidsmapÂ had a helpful write-up of her presentation, which isÂ available here.Â Thanks to co-author Susan Allen for alerting us to this.
CVCT (couples voluntary counseling and treatment) greatly enhanced the preventive effect of antiretroviral treatment, when compared to treatment without counselling, Wall’sÂ analysis of a large cohort of couplesÂ in Zambia showed.Â
Update: Allen points out that couples counselingÂ by itselfÂ was effective in helping people avoid HIV, with a 75 percent reduction in incidence for couples where the HIV+ partner was not receiving antiviral therapy or with HIV negative couples.Â
In CVCT , heterosexual couples are counselled together when considering an HIV test, take the test together, and are counselled together on the implications of the result. According to the CDC,Â the object of counseling couples rather than individuals is to mitigate tension, diffuse blame, and create an environment in which disclosure of status can be accomplished safely.
One key factor is that adherence in the â€˜real-lifeâ€™ setting of Zambia is very poor. One survey quoted by Wall found that only 60% of people taking ART in Zambia were adequately adherent and that, in addition to this, 25% dropped out of care per year…
A number of studies have teased apart the contributors to poor adherence in Zambia. Ones that appear consistently are food insecurity, long distances to clinic, poor information about treatment, and some faith practices. The most consistent predictor of poor adherence, however, said Wall, was lack of disclosure between couples. Adherence was very poor in people who had not disclosed that they had HIV to their partner, especially as disclosure often involved relationship break-up and, very often for women living with HIV, violence.
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