Serodiscordant

Last updated

A serodiscordant relationship, also known as mixed-status, is one where one partner is infected by HIV and the other is not. [1] This contrasts with seroconcordant relationships, in which both partners are of the same HIV status. Without effective prevention measures, serodiscordant relationships can significantly contribute to the spread of HIV/AIDS, with the risk varying based on the type and frequency of sexual activity and the viral load of the HIV-positive partner. [2]

Globally, an estimated 34 million people are living with HIV, with 68% residing in sub-Saharan Africa nations such as Lesotho [3] and 50% of cases affecting women. In the United States, over 140,000 HIV-serodiscordant heterosexual couples are estimated, with 52% of HIV-positive women in a national study reporting serodiscordant partnerships. Similarly, in sub-Saharan Africa, 47% of HIV-positive women are in stable serodiscordant relationships. [4] The World Health Organization reports that up to 50% of individuals living with HIV in ongoing relationships worldwide have partners who are HIV-negative. [5]

Serodiscordant couples face numerous issues not faced by seroconcordant couples, including decisions as to what level of sexual activity is comfortable for them, knowing that practicing safer sex reduces but does not eliminate the risk of transmission to the HIV-negative partner. There are also potential psychological issues arising out of taking care of a sick partner, and survivor guilt [6] . Psychological impacts included anger, fear, grief, and loss of control, often exacerbated by the secrecy surrounding their partner's status. Financial strains may also be more accentuated as one partner becomes ill and potentially less able or unable to work. [7]

Research involving serodiscordant couples has offered insights into how the virus is passed and how individuals who are HIV positive may be able to reduce the risk of passing the virus to their partner. [8]

Experts predict that there are thousands of serodiscordant couples in the US who wish to have children, [9] and researchers report a growing stream of calls from these couples wanting reproductive help. [10] The Special Program of Assisted Reproduction was developed in 1996 to help serodiscordant couples conceive safely, however, it is solely designed to help couples where the male partner is infected.

The WHO's consolidated guideline on sexual and reproductive health and rights for women living with HIV provides strategies to minimize HIV transmission risks in serodiscordant relationships when planning pregnancy. Key recommendations include antiretroviral therapy (ART) to suppress the viral load in the HIV-positive partner, pre-exposure prophylaxis (PrEP) for the HIV-negative partner, timing unprotected intercourse during peak fertility, screening and treating sexually transmitted infections in both partners, voluntary medical male circumcision for HIV-negative men, and assisted reproductive techniques such as semen insemination. [11]

See also

Related Research Articles

<span class="mw-page-title-main">Chlamydia</span> Sexually transmitted infection caused by the bacterium Chlamydia trachomatis

Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Most people who are infected have no symptoms. When symptoms do appear they may occur only several weeks after infection; the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks. Symptoms in women may include vaginal discharge or burning with urination. Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles. The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy.

<span class="mw-page-title-main">Safe sex</span> Ways to reduce the risk of acquiring STIs

Safe sex is sexual activity using methods or contraceptive devices to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.

The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.

<span class="mw-page-title-main">HIV/AIDS in Africa</span>

HIV/AIDS originated in the early 20th century and has become a major public health concern and cause of death in many countries. AIDS rates vary significantly between countries, with the majority of cases concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – approximately 35 million people – were Africans, of whom around 1 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 100 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, leading to raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life-expectancy in some countries reaching as low as thirty-nine years.

The spread of HIV/AIDS has affected millions of people worldwide; AIDS is considered a pandemic. The World Health Organization (WHO) estimated that in 2016 there were 36.7 million people worldwide living with HIV/AIDS, with 1.8 million new HIV infections per year and 1 million deaths due to AIDS. Misconceptions about HIV and AIDS arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that deny a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.

HIV-positive people, seropositive people or people who live with HIV are people infected with the human immunodeficiency virus (HIV), a retrovirus which if untreated may progress to acquired immunodeficiency syndrome (AIDS).

Serosorting, also known as serodiscrimination, is the practice of using HIV status as a decision-making point in choosing sexual behavior. The term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus to engage in unprotected sex with them for a reduced risk of acquiring or transmitting HIV/AIDS.

<span class="mw-page-title-main">Sexually transmitted infection</span> Infection transmitted through human sexual behavior

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of transmitting them on to others. The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes cases with no symptomatic disease. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

<span class="mw-page-title-main">HIV/AIDS in Lesotho</span>

HIV/AIDS in Lesotho constitutes a very serious threat to Basotho and to Lesotho's economic development. Since its initial detection in 1986, HIV/AIDS has spread at alarming rates in Lesotho. In 2000, King Letsie III declared HIV/AIDS a natural disaster. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2016, Lesotho's adult prevalence rate of 25% is the second highest in the world, following Eswatini.

<span class="mw-page-title-main">HIV/AIDS in Haiti</span>

With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk-factor groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission.

AIDS Information Centre-Uganda (AIC) is a Non-Governmental Organization in Uganda established in 1990 to provide Voluntary Counseling and Testing (VCT) for Human Immune Deficiency Virus (HIV). The Organization was founded as a result of growing demand from people who wanted to know their HIV status. At this time the HIV/AIDS in Uganda was high.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

<i>How to Have Sex in an Epidemic</i> 1983 book by Richard Berkowitz and Michael Callen

How to Have Sex in an Epidemic: One Approach is a 1983 manual by Richard Berkowitz and Michael Callen, under the direction of Joseph Sonnabend, to advise men who have sex with men (MSM) about how to avoid contracting the infecting agent which causes AIDS. It was among the first publications to recommend the use of condoms to prevent the transmission of STDs in men having sex with men, and has even been named, along with Play Fair!, as one of the foundational publications in the advent of modern safe sex.

Since reports of emergence and spread of the human immunodeficiency virus (HIV) in the United States between the 1970s and 1980s, the HIV/AIDS epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981, and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi's sarcoma, and eight had died less than 24 months after the diagnosis was made.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

Breastfeeding by HIV-infected mothers is the practice of breastfeeding of HIV-infected mothers and include those who may want to or are currently breastfeeding. HIV can be transmitted to the infant through breastfeeding. The risk of transmission varies and depends on the viral load in the mother's milk. An infant can be infected with HIV throughout the duration of the pregnancy or during childbirth (intrapartum).

<span class="mw-page-title-main">Elioda Tumwesigye</span> Ugandan politician

Elioda Tumwesigye is a Ugandan politician, physician, and epidemiologist who has served as minister of science, technology and innovation in the cabinet of Uganda since June 2016. From March 2015 until June 2016, he served as the minister of health.

Many women have been infected with the HIV/AIDS virus. The majority of HIV/AIDS cases in women are directly influenced by high-risk sexual activities, injectional drug use, the spread of medical misinformation, and the lack of adequate reproductive health resources in the United States. Women of color, LGBT women, homeless women, women in the sex trade, and women intravenous drug users are at a high-risk for contracting the HIV/AIDS virus. In an article published by the Annual Review of Sociology, Celeste Watkins Hayes, an American sociologist, scholar, and professor wrote, "Women are more likely to be forced into survival-focused behaviors such as transactional sex for money, housing, protection, employment, and other basic needs; power-imbalanced relationships with older men; and other partnerings in which they cannot dictate the terms of condom use, monogamy, or HIV." The largest motivator to become part of the sex trade was addiction, the second largest being basic needs, and the third was to support their children/family.

Elizabeth Anne Bukusi FAAS is a research professor working within the field of obstetrics and gynaecology, and global health. Bukusi's main areas of research focus around sexually transmitted infections, women's health, reproductive health, and HIV care, prevention and treatment. Bukusi is the Chief Research Officer at the Kenya Medical Research Institute (KEMRI) and led a "landmark" study on the use of PrEP in Kenya.

Undetectable = Untransmittable (U=U) is a message used in HIV campaigns. It means that if someone has an undetectable viral load, they cannot sexually transmit HIV to others. U=U is supported by numerous health groups and organisations worldwide, including the World Health Organization (WHO). The validity of U=U has been proven through many clinical trials involving thousands of couples. U=U is also used as an HIV prevention strategy: if someone is undetectable, they cannot pass it further and hence, prevent the virus from spreading. This is known as Treatment as Prevention (TasP).

References

  1. ↑ Lelaka, Constance Matshidiso; Moyo, Idah; Tshivhase, Livhuwani; Mavhandu-Mudzusi, Azwihangwisi Helen (2022-12-31). "Psychosocial support for HIV serodiscordant couples". Health Psychology and Behavioral Medicine. 10 (1): 537–556. doi:10.1080/21642850.2022.2084098. PMC   9225695 . PMID   35756334.
  2. ↑ Lasry, Arielle; Sansom, Stephanie L.; Wolitski, Richard J.; Green, Timothy A.; Borkowf, Craig B.; Patel, Pragna; Mermin, Jonathan (2014-06-19). "HIV sexual transmission risk among serodiscordant couples: assessing the effects of combining prevention strategies". AIDS. 28 (10): 1521–1529. doi:10.1097/QAD.0000000000000307. ISSN   0269-9370. PMC   7797164 . PMID   24804859.
  3. ↑ Makwe, Christian C., and Osato F. Giwa-Osagie. “Sexual and Reproductive Health in HIV Serodiscordant Couples.” African Journal of Reproductive Health / La Revue Africaine De La Santé Reproductive, vol. 17, no. 4, 2013, pp. 99–106. JSTOR, JSTOR, www.jstor.org/stable/24362091.
  4. ↑ Mmeje, Okeoma; Cohen, Craig R.; Cohan, Deborah (2012). "Evaluating Safer Conception Options for HIV-Serodiscordant Couples (HIV-Infected Female/HIV-Uninfected Male): A Closer Look at Vaginal Insemination". Infectious Diseases in Obstetrics and Gynecology. 2012: 1–7. doi: 10.1155/2012/587651 . ISSN   1064-7449. PMC   3423871 . PMID   22927714.
  5. ↑ "Learning to live as a couple when one partner is HIV-positive in Sierra Leone | WHO | Regional Office for Africa". www.afro.who.int. 2024-11-29. Retrieved 2024-11-30.
  6. ↑ Schönnesson, Lena Nilsson; Ross, Michael W. (1999). Coping with HIV Infection: Psychological and Existential Responses in Gay Men. AIDS Prevention and Mental Health. Boston, MA: Springer. ISBN   978-1-4613-7119-9.
  7. ↑ Larki, Mona; Bahri, Narjes; Moghri, Javad; Latifnejad Roudsari, Robab (April 2020). "Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women". International Journal of Community Based Nursing & Midwifery. 8 (2): 103–115. doi:10.30476/ijcbnm.2020.82845.1093. PMC   7153425 . PMID   32309452.
  8. ↑ Grace Kimemia G (June 2019). "Perceptions of pregnancy occurring among HIV-serodiscordant couples in Kenya". Reproductive Health. 16 (85): 85. doi: 10.1186/s12978-019-0751-4 . PMC   6582525 . PMID   31215447.
  9. ↑ Mmeje, Okeoma; Cohen, Craig R.; Cohan, Deborah (2012). "Evaluating Safer Conception Options for HIV-Serodiscordant Couples (HIV-Infected Female/HIV-Uninfected Male): A Closer Look at Vaginal Insemination". Infectious Diseases in Obstetrics and Gynecology. 2012: 1–7. doi: 10.1155/2012/587651 . ISSN   1064-7449. PMC   3423871 . PMID   22927714.
  10. ↑ Coleman-Sarfo, Kate; Klo, Emmanuel DeGraft (2017-08-15). "Challenges Faced by HIV Positive Partners Living in Discordance with HIV Negative Partners: A Case Study of 37 Military Hospital". ():-.
  11. ↑ "Consolidated guideline on sexual and reproductive health and rights of women living with HIV – Guideline". www.who.int. Retrieved 2024-11-30.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.