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One in ten cohabiting couples in Mozambique is discordant, that is, one member is HIV-positive while the other is HIV-negative. In recent years, interest in the spread of HIV within stable sexual partnerships has increased. The 2009 Mozambique INSIDA collected information on HIV serostatus, risk behaviors, and other background characteristics, allowing cohabitating couples to be matched and analyzed together. This investigation has two complementary objectives: (1) to estimate the number of discordant couples in Mozambique and to provide useful information about these couples, and (2) to identify factors that may help to protect the HIV-negative partner from becoming infected. The report includes a discussion of how the couples data file is created and its representativeness of the population of cohabiting couples in Mozambique, data on the distribution of couples by HIV status and estimates for the number of discordant couples in Mozambique, and multivariate models to identify factors associated with discordance.
A couples file was created from the 2009 INSIDA database of male and female respondents age 15-64. This file includes cohabiting couples, that is, couples in which the husband and wife live together in the same household. This investigation includes all of the cohabiting couples in which the husband and wife were successfully matched and for whom information was available from both members of the couple for the individual interview and HIV test, a total of 2,490 unweighted couples (2,648 weighted). The included couples were found to be representative of all men and women in the main INSIDA database who reported that they were married with respect to key demographic variables and HIV status.
As of 2009, there were an estimated 433,000 discordant couples in Mozambique. One-third of all HIV-positive individuals age 15-64 were married to someone who is uninfected, suggesting that discordance may be responsible for a substantial percentage of all new HIV infections. In 51 percent of discordant couples neither member had ever been tested for HIV and received the results, and at least 85 percent of couples who are discordant do not know it, ranging from 77 percent in the southern region (Maputo, Gaza, and Inhambane provinces) to 98 percent in the northern region (Nampula, Cabo Delgado, and Niassa provinces). Eleven percent of discordant couples in which the woman is HIV-positive used a condom the last time they had sex with each other compared with only one percent of discordant couples in which the man is HIV-positive.
Results from multinomial logistic regression analyses show that factors associated with transmission from women to men in a couple differ from factors associated with transmission from men to women. In both binomial and multinomial logistic regression models, couples in which neither member has had an STI in the past year are more likely to be discordant than couples in which either member has had an STI. Although the cross-sectional nature of the data does not allow determination of causality, this finding is consistent with a statistically significant association between presence of an STI and increased risk of HIV transmission within a discordant couple.
Discordant couples are an important population at risk for new HIV infection in Mozambique due both to the size of the population, as calculated in this report, and to the elevated risk of transmission from one spouse to the other, as shown in the scientific literature reviewed in this report on the incidence of HIV among discordant couples. Knowledge of status and condom use among discordant couples are low. Key recommendations include increasing awareness about serodiscordancy, increasing demand for and access to HIV counseling and testing for couples, and strengthening STI screening and surveillance.