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HIV Status Awareness, Partnership Dissolution and HIV Transmission in Generalized Epidemics

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  • Georges Reniers
  • Benjamin Armbruster

Abstract

Objectives: HIV status aware couples with at least one HIV positive partner are characterized by high separation and divorce rates. This phenomenon is often described as a corollary of couples HIV Testing and Counseling (HTC) that ought to be minimized. In this contribution, we demonstrate the implications of partnership dissolution in serodiscordant couples for the propagation of HIV. Methods: We develop a compartmental model to study epidemic outcomes of elevated partnership dissolution rates in serodiscordant couples and parameterize it with estimates from population-based data (Rakai, Uganda). Results: Via its effect on partnership dissolution, every percentage point increase in HIV status awareness reduces HIV incidence in monogamous populations by 0.27 percent for women and 0.63 percent for men. These effects are even larger when the assumption of monogamy can be relaxed, but are moderated by other behavior changes (e.g., increased condom use) in HIV status aware serodiscordant partnerships. When these behavior changes are taken into account, each percentage point increase in HIV status awareness reduces HIV incidence by 0.13 and 0.32 percent for women and men, respectively (assuming monogamy). The partnership dissolution effect exists because it decreases the fraction of serodiscordant couples in the population and prolongs the time that individuals spend outside partnerships. Conclusion: Our model predicts that elevated partnership dissolution rates in HIV status aware serodiscordant couples reduce the spread of HIV. As a consequence, the full impact of couples HTC for HIV prevention is probably larger than recognized to date. Particularly high partnership dissolution rates in female positive serodiscordant couples contribute to the gender imbalance in HIV infections.

Suggested Citation

  • Georges Reniers & Benjamin Armbruster, 2012. "HIV Status Awareness, Partnership Dissolution and HIV Transmission in Generalized Epidemics," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-7, December.
  • Handle: RePEc:plo:pone00:0050669
    DOI: 10.1371/journal.pone.0050669
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    References listed on IDEAS

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    1. Kirsten P. Smith & Susan Cotts Watkins, 2005. "Perceptions of Risk and Strategies for Prevention: Responses to HIV/AIDS in Rural Malawi," PGDA Working Papers 0305, Program on the Global Demography of Aging.
    2. Laura Porter & Lingxin Hao & David Bishai & David Serwadda & Maria Wawer & Thomas Lutalo & Ronald Gray, 2004. "Hiv status and union dissolution in Sub-saharan Africa: The case of Rakai, Uganda," Demography, Springer;Population Association of America (PAA), vol. 41(3), pages 465-482, August.
    3. Georges Reniers, 2008. "Marital strategies for regulating exposure to HIV," Demography, Springer;Population Association of America (PAA), vol. 45(2), pages 417-438, May.
    4. Damien De Walque, 2007. "Sero‐Discordant Couples in Five African Countries: Implications for Prevention Strategies," Population and Development Review, The Population Council, Inc., vol. 33(3), pages 501-523, September.
    5. Smith, Kirsten P. & Watkins, Susan Cotts, 2005. "Perceptions of risk and strategies for prevention: responses to HIV/AIDS in rural Malawi," Social Science & Medicine, Elsevier, vol. 60(3), pages 649-660, February.
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    1. Georges Reniers & Benjamin Armbruster & Aaron Lucas, 2015. "Sexual networks, partnership mixing, and the female-to-male ratio of HIV infections in generalized epidemics," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 33(15), pages 425-450.

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