Two months after Maripaz Callejas' husband died of AIDS, she was diagnosed with HIV. One doctor told her that she would be dead within five years.
In Maripaz's home country, El Salvador, many new HIV infections occur as a result of unprotected sex between couples who are married or living together. WHO estimates that globally as many as half of all HIV-positive people in long-term relationships have HIV-negative partners — forming what are known as serodiscordant couples. It is estimated that half of people living with HIV still do not know that they are infected, and, like Maripaz, many people in relationships do not know their partner's status.
Couples should get tested together
That is why WHO recommends that couples get tested for HIV — and counselled — together. Receiving voluntary HIV testing and counselling as a couple means that both partners get tested together, receive their results and share their status with the support of a counsellor. A range of prevention, treatment and support options can then be discussed and decided upon together.
Maripaz is now married to Moises Marinero. Moises was aware of Maripaz's HIV-positive status from the beginning. Maripaz was reluctant to start a new relationship at first, but a counsellor told her that it was safe to have sex, provided she always used a condom. She has been on HIV medication, antiretroviral drugs (ARVs), since 2002. Today, she remains healthy and Moises is still HIV-negative.
Maripaz was fortunate that Moises knew that she was HIV-positive and how to protect himself.
Living together as a serodiscordant couple
Life was initially tougher for Godfrey and Paulina Mtonga of Lusaka, Zambia. The couple have now been married for 32 years. They have 11 children and 8 grandchildren. In 1994, they went for HIV testing together. Godfrey was positive and Paulina negative.
"The first week was very bad for us," Godfrey recalls. "The counsellor came to visit us the very next day." The counsellor kept coming, and the couple decided to stay together. They continued to have a sexual relationship, using condoms from a nearby clinic. Godfrey started taking antiretroviral treatment in 2002. Pauline has remained HIV-negative.
Godfrey Mtonga's advice to everyone is to get tested. "If you are positive, love each other and take your medicine at the right time. We have lived with our status as a discordant couple for the past 18 years because we support each other."
Some countries—such as Kenya, Rwanda, Thailand, Zambia and others—have already introduced HIV testing and counselling for couples with a view to helping them support one another. Couples testing can be provided as part of pregnancy care or other health services, in peoples' homes and as part of outreach testing in communities, as well as in voluntary testing and counselling sites.
New guidance on couples HIV testing and counselling
In addition to correct and consistent use of condoms, counsellors may suggest that the HIV-positive partner take antiretroviral drugs, regardless of his or her immune status. Studies show that this can both keep the positive partner healthier for longer, and reduce the risk they will pass the virus to their loved one. This finding prompted WHO to issue new guidance on couples HIV testing and counselling in April 2012 — including antiretroviral therapy for treatment and prevention in serodiscordant couples.
In addition to Zambia, which has recommended early ARVs for the positive partner in a serodiscordant couple since 2010, other countries—including Canada, China, Kenya and many in western Europe—currently recommend or are considering the use of ARVs to reduce HIV transmission in serodiscordant couples.