Couples’ Voluntary Counseling and Testing: From Heterosexuals in Sub-Saharan Africa to MSM in the United States by Megan Murphy

Dr. Susan Allen is one of my scientific heroes. Spending mere minutes with or listening to her yields full understanding of the inspiring passion and tenacity she brings to HIV-1 issues in public health. Dr. Allen established two heterosexual HIV-discordant couple cohorts (meaning one partner is HIV positive, one partner is HIV negative) in sub-Saharan Africa several decades ago: Projet San Francisco (PSF) in Kigali, Rwanda in 1986 and the Zambia-Emory HIV Research Project (ZEHRP) in Lusaka, Zambia in 1994 [1]. Samples from patients seen at the PSF and ZEHRP cohorts fuel my current graduate research. Two additional cohorts, with which I am only minimally familiar, are located in the Copperbelt region of Zambia in the villages of Ndola and Kitwe. All of these mentioned cohorts target heterosexual couples because this is the most significantly affected population in the geographical context of sub-Saharan Africa.

The approach employed at the PSF and ZEHRP cohorts is called couples’ voluntary counseling and testing or CVCT. Heterosexual, typically cohabiting and monogamous, couples are given condoms, HIV tested, and counseled about the risk of transmission to the negative partner as a dyad. This preventative strategy focuses on the unit of a relationship rather than the individual. Research supports the efficacy of this methodology where “targeting couples in HIV prevention efforts—in particular couples-based HIV counseling and testing—has been shown to be effective in reducing transmission between sero-discordant couples, increasing condom use, and reducing sexual risk-taking” [2].

As you might remember, I forwarded a CBS article link [3] to class members near the beginning of February. It was, in fact, the first time that I had heard about the CVCT approach migrating to the United States, and I was excited. In that piece, one of this week’s speakers (Rob Stephenson) commented on a program recently launched in Chicago and Atlanta called “Testing Together” that is financed by the MAC AIDS Fund and that “hopes to test 400 [MSM] couples by the end of the year.” Stephenson said, “The idea is to bring honesty to sexual relationships…Relationships offer only ‘mythical protection’ from HIV…Some couples may have avoided talking about each other’s HIV status, thinking, ‘If he were HIV positive he would have told me,’ or ‘If he wanted to know, he would have asked’” [3]. Program efforts target MSM because, unlike Africa, this population represents the majority of new infections in the United States.

Stephenson and colleagues flesh out the foundation for programs such as “Testing Together” in one of this week’s readings [2]. Initially, it was important to understand what changes would have to be made in order to adapt the heterosexual CVCT approach in Africa to appropriately target US MSM. Interviewing of focus groups in three US cities (Atlanta, Chicago, and Seattle), composed of 39 Caucasian or African American MSM, found that “CVCT was seen as a sign of commitment within a relationship and was reported to be more appropriate for men in longer-term relationships. CVCT was also seen as providing a forum for the discussion of risk-taking within the relationship” [2]. The study ultimately supports the idea that, with some alteration, the CVCT approach could prove effective as a preventative/educational strategy to combat HIV-1 transmission in the United States.



2.Stephenson, R., P. S. Sullivan, L. F. Salazar, B. Gratzer, S. Allen, E. Seelbach. “Attitudes Towards Couples-Based HIV Testing Among MSM in Three US Cities.” AIDS Behav (2011) 15:S80-S87.



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