HIV Couples Counseling and Testing: How the dynamics of relationships can reduce the spread of HIV

In parts of Africa, Couples voluntary counseling and testing (CVCT) among heterosexual couples, in which one person is HIV-positive and the other HIV-negative, has been shown to reduce the spread of HIV and increase the uptake of protective behavioral changes (such as increased frequency of condom usage).  In a study published in 2011, researchers assessed the acceptability of CVCT among men who have sex with men (MSM) in three U.S. cities:  Atlanta, Chicago, and Seattle.

In the U.S., the MSM population continues to be disproportionately impacted by HIV, with 53% of annual new infections coming solely from this group.  A common misconception regarding HIV transmission is that most of it occurs among individuals who have sex with casual or random partners.  However, a recent study estimated that a majority of new HIV infections among MSM are likely attributable to sex with main or primary partners.  As such, CVCT has the potential to prevent the spread of HIV within this high-risk population by engaging people in the context of a relationship.

Rapid Oral HIV Tests

Study results showed that overall, participants were overwhelmingly in favor of CVCT services.  The most common reasons supporting the use of CVCT included:

• Undergoing CVCT with one’s partner represented that both individuals were committed to their relationship.
• CVCT provided an environment that would allow people receiving their HIV test results to receive emotional support from their partner.
• CVCT provides a forum in which partners can disclose their HIV status to each other and discuss and/or alter behaviors that place at risk for becoming infected.

There are certain things that should be assessed before CVCT is included in the standard array of HIV prevention services offered.  They include:

Intervention Adaptation

Although CVCT was found to be effective among heterosexual couples in Africa, we really have no idea whether these results can be replicated among MSM couples in the U.S.  Pilot studies should be implemented on a smaller scale basis to provide evidence that the intervention is effective.  Based on these results, CVCT may be further adapted to fit the needs of the target population.

Who to Target

Which brings about another point:  Who specifically, should we target with CVCT services?  The study mentioned that these services might not be appropriate for people in the early stages of a relationship.  Those who are in long-term and stable relationships may be better able to withstand the emotional rollercoaster that comes along with a positive test result.  Therefore, a screening process may be required before a couple is eligible to receive these types of services.

CVCT Infrastructure and Counselor Training

Traditionally, HIV counseling and testing procedures in the U.S. have been implemented in a 1-to-1 setting, where the counselor administers the test, provides risk-reduction education messages, and discloses the person’s HIV test results.  Situations can become much more complicated when counselors must go through the counseling and testing process with couples as opposed to individuals.  For instance, during a counseling and disclosure session, an individual may find out his partner had been having sexual relations with another person, or may discover that his partner tested positive for HIV. 

Either of these scenarios may bring about a range of emotions or physical acts of violence that may bring about the dissolution of a relationship.  Counselors must be prepared for this and have the ability to placate a potentially hostile environment.  Not only do we need to worry about whether these services are acceptable to the group of people who may utilize such services, but we also need to evaluate whether HIV counselors in their current state, have the capacity to implement and effectively manage CVCT services.  If not, current HIV counseling and testing requirements, guidelines, and trainings must be revamped in order to take into account changing circumstances.

HIPAA Requirements

Since the U.S. has very strict confidentiality requirements when it comes to an individual’s health records, the CVCT process would need to ensure that consent to share HIV test results is obtained and documented for each individual. 

The primary author of the study concluded that “CVCT is an acceptable format for HIV counseling and testing among men who have sex with men in this study, and if adapted and promoted well, could fill a significant gap in couples-based services for US men. By providing a forum in which couples can learn and share their sero-status, CVCT may help couples to be counseled on developing plans for behavioral change, and provide an opportunity to increase condom use and decrease risk-taking behaviors."

Source:  Stephenson R, Sullivan PS, Salazar LF, Gratzer B, Allen S, and Seelbach E.  “Attitudes Towards Couples-Based HIV Testing among MSM in Three US Cities”.  AIDS Behavior (2011): 15:S80-S87.


Min Kim, MPH is a 1st year PhD student in the Department of Epidemiology at Emory University.