Inter Press Service - May 10, 2006
Wilson Johwa

"I would meet a girl, use a condom, but after four months stop using them," he says.

But surprisingly his second wife, Grace, does not have the virus. The pair has joined other couples which have a mismatched HIV status, something also known as HIV discordance.

Between 13 and 36 percent of couples in South Africa may be in discordant relationships, says Dr Sinead Delany-Moretlwe of the Reproductive Health and HIV Unit (RHRU) at the University of the Witwatersrand, in the financial centre of Johannesburg.

However, researchers have yet to understand fully why the AIDS virus is not transmitted between these partners, even when they fail to practice safe sex. "It's such a new concept, even medical people are baffled by it," observes Dr Mamazane Maduna, also with the RHRU.

What scientists do know is that HIV discordance is related to a combination of factors that include genetics, HI-virus type, the extent to which the infection has progressed in the HIV-positive partner, other sexually-transmitted diseases and circumcision -- which research indicates may reduce the risk of HIV infection.

"The virus is not systematically transmitted at each and every sexual encounter, and also depends on how far the HIV-positive person is in the progression of his condition," says Zimbabwe-based Dr Alexander Boon of the Spanish chapter of Doctors Without Borders, a non-governmental organisation.

A study is currently underway in six African countries, in a bid to unravel the mysteries of HIV discordance -- in particular, whether treating the virus that causes genital herpes reduces the risk of HIV transmission between those in discordant relationships.

"What we know about herpes is that it seems to have a special relationship with HIV," says Delany-Moretlwe, who -- with Maduna -- is assisting with the research. A person with herpes is believed to be three times more likely to become infected by HIV.

Conducted in partnership with the University of Washington with funding from the Bill and Melinda Gates Foundation, the study is being carried out at 13 sites in South Africa, Botswana, Kenya, Uganda, Zambia and Rwanda. (The foundation, established by software billionaire Bill Gates, is based in the north-western American city of Seattle.)

South Africa has three sites, one at Orange Farm, a sprawling informal settlement located just south of Johannesburg. Since the programme began in August last year, 314 couples have been tested there, 80 of which were HIV discordant. Thirty-seven of the discordant couples are now participating in trials.

As biological and social factors are known to increase women's vulnerability to HIV, the assumption might be that it is typically the man in discordant relationships who is HIV-negative. However, HIV infection occurred equally amongst men and women in discordant relationships who were tested at Orange Farm.

Problems arise with what Delany-Moretlwe describes as "testing by proxy", where someone may assume they are free of HIV because their partner tested negative.

But in the course of ascertaining HIV status, extensive pre-test and post-test counselling of couples can help discordant partners to stay together. "They seem very supportive of each other," says Delany- Moretlwe. "People become protective of their partner."

Silas and Grace appear set to remain a couple. "You know we are happy, very happy together," says Grace.

She has even accepted that her husband may die sooner that he otherwise would have. "I'm ready for whatever comes," she says. "What kills people is not accepting."

Since testing positive Silas has stopped drinking, save for the occasional glass of non-alcoholic wine. He is also more open with his finances, says Grace, and willing to plan with her for the future.

Sex, however, only takes place with a condom -- even though discordance has prevented Silas from transmitting the AIDS virus to Grace in the past.

"It should be planned in order to protect her," says Silas. "It's no longer controlled by my feelings."

But would he have stayed with her if Grace had been the one who tested HIV positive?

"I don't know," Silas chuckles. "It would have been something about how she approached me."

* Names have been changed to protect the privacy of those concerned.

060510
IP060503

Always watch for outdated information. This article first appeared in 2006. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .