The Kenyan government has issued guidelines on counselling for HIV-discordant couples, but many counsellors in smaller, rural health centres remain untrained.
"HIV infection among discordant couples will increase without adequate counselling because... it is only through counselling that they learn to live with each other, and use preventive measures such as condoms consistently," said Churchill Alumasa, the coordinator at the local NGO, Discordant Couples of Kenya (DISCOK).
According to the government, six out of every 10 HIV-positive couples are discordant, amounting to an estimated 350,000 couples.
When Rose Njeri, 31, a mother of one, tested HIV-positive two years ago during a routine antenatal visit, she was advised to bring her husband along for her next visit. When he tested negative, he became hostile towards her.
"Trouble started immediately. He insulted me as we headed home, saying I knew my status and wanted to infect him intentionally," Njeri told IRIN/PlusNews.
Couples counselling
The couple was given a counselling session on safe sex, but Njeri said her husband sometimes insists on unprotected sex when he comes home drunk.
"It is also important to note that couples counselling cannot be done once. It needs to be continuous, especially if there is a case of discordance," said Vivian Mwenesi, a counsellor at a health facility in the capital, Nairobi.
Studies show that couple counselling and testing not only lowers risky behaviour, but can also significantly decrease the risk of HIV infection.
"Challenges associated with discordance can be reduced if counsellors test couples together and they benefit from knowing each other's status at the same time, and in the presence of a counsellor,” said DISCOK's Alumasa.
“[Counsellors] should also dedicate more time to these couples because their cases are normally different," he said, and mistrust and engaging in risky sexual behaviour can be diminished by ensuring that couples are tested together, rather than separately.
Yet Mwenesi noted that many couples preferred to test individually rather than together, thereby missing out on the opportunity for couples counselling. "If you insist on testing them together, some disappear forever," she said.
Children
The unmet reproductive health needs of HIV-discordant couples are a key issue and needs to be addressed. "Discordant couples who are not counselled together are likely to engage in unprotected sex in search of a child, and [if] one partner doesn't know the status of the other, they find it hard to discuss condom use," Mwenesi said. "For discordant couples, condoms remain the most effective contraceptive, but their use can only improve in a situation where there is vibrant couples counselling."
A number of reproductive options exist for HIV-discordant couples, including artificial insemination after 'sperm washing', and the infected partner starting antiretroviral therapy (ART) to decrease the chances of transmission to the HIV-negative partner. However, counsellors are often not equipped to provide couples with this information.
Health workers are awaiting guidelines on HIV-discordant couples from the UN World Health Organization. These were due to be released in 2011 but were delayed by findings on the impact of early treatment on reducing HIV infection within stable sexual relationships.
Experts say home-based counselling and testing and psychosocial support groups are also helpful tools in reaching out to discordant couples.
Nicholas Muraguri, head of Kenya's National AIDS and Sexually transmitted infections Control Programme, noted that "Involvement of partners in prevention programmes, such as medical male circumcision and prevention of mother-to-child transmission programmes, provides for a greater opportunity to provide couple counselling."
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"HIV infection among discordant couples will increase without adequate counselling because... it is only through counselling that they learn to live with each other, and use preventive measures such as condoms consistently," said Churchill Alumasa, the coordinator at the local NGO, Discordant Couples of Kenya (DISCOK).
According to the government, six out of every 10 HIV-positive couples are discordant, amounting to an estimated 350,000 couples.
When Rose Njeri, 31, a mother of one, tested HIV-positive two years ago during a routine antenatal visit, she was advised to bring her husband along for her next visit. When he tested negative, he became hostile towards her.
"Trouble started immediately. He insulted me as we headed home, saying I knew my status and wanted to infect him intentionally," Njeri told IRIN/PlusNews.
Couples counselling
The couple was given a counselling session on safe sex, but Njeri said her husband sometimes insists on unprotected sex when he comes home drunk.
"It is also important to note that couples counselling cannot be done once. It needs to be continuous, especially if there is a case of discordance," said Vivian Mwenesi, a counsellor at a health facility in the capital, Nairobi.
Studies show that couple counselling and testing not only lowers risky behaviour, but can also significantly decrease the risk of HIV infection.
"Challenges associated with discordance can be reduced if counsellors test couples together and they benefit from knowing each other's status at the same time, and in the presence of a counsellor,” said DISCOK's Alumasa.
“[Counsellors] should also dedicate more time to these couples because their cases are normally different," he said, and mistrust and engaging in risky sexual behaviour can be diminished by ensuring that couples are tested together, rather than separately.
 Trouble started immediately. He insulted me as we headed home, telling me I knew my [HIV] status and wanted to infect him intentionally |
Children
The unmet reproductive health needs of HIV-discordant couples are a key issue and needs to be addressed. "Discordant couples who are not counselled together are likely to engage in unprotected sex in search of a child, and [if] one partner doesn't know the status of the other, they find it hard to discuss condom use," Mwenesi said. "For discordant couples, condoms remain the most effective contraceptive, but their use can only improve in a situation where there is vibrant couples counselling."
A number of reproductive options exist for HIV-discordant couples, including artificial insemination after 'sperm washing', and the infected partner starting antiretroviral therapy (ART) to decrease the chances of transmission to the HIV-negative partner. However, counsellors are often not equipped to provide couples with this information.
Health workers are awaiting guidelines on HIV-discordant couples from the UN World Health Organization. These were due to be released in 2011 but were delayed by findings on the impact of early treatment on reducing HIV infection within stable sexual relationships.
Experts say home-based counselling and testing and psychosocial support groups are also helpful tools in reaching out to discordant couples.
Nicholas Muraguri, head of Kenya's National AIDS and Sexually transmitted infections Control Programme, noted that "Involvement of partners in prevention programmes, such as medical male circumcision and prevention of mother-to-child transmission programmes, provides for a greater opportunity to provide couple counselling."
rk/ko/kr/he
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