Recommendations for Treatment as Prevention Among Heterosexual HIV Discordant Couples: A South African Case Study

The Human Immunodeficiency Virus (HIV) epidemic remains a major public health crisis even after thirty years of research. Despite great strides in the prevention and treatment of HIV-infected individuals, sexual transmissions continue worldwide and especially in sub-Saharan Africa (UNAIDS, 2013). Moreover, the increasing presence of heterosexual HIV discordant couples, where one partner in the couple is HIV-positive and the other is HIV-negative, presents unique challenges. Low perceptions of HIV risk and inadequate prevention strategies among this subpopulation fuel sexual transmissions. The WHO and UNAIDS recommend that targeted strategies be applied systematically which effectively treat the infected partner for his/her own health but also prevent HIV transmission to the uninfected partner (WHO, 2012). The proposed modality for accomplishing this task in this subpopulation is known as "treatment as prevention." The landmark HPTN 052 trial where the infected person received HIV antiretroviral therapy (ART) early in infection, which suppressed HIV and protected the infected person's immune system, but also reduced HIV transmission to the uninfected partner, confirmed this was as a promising method for reducing HIV incidence among discordant couples (Cohen et al., 2011). Harnessing information learned from discordant couples' studies, recommendations are presented as part of a comprehensive treatment as prevention program tailored to this subpopulation. These global recommendations include couples testing and counseling, condom education, education about and access to ART, and use of social marketing for implementation and optimal results. These recommendations are evaluated for their potential benefits in the context of a South African Case Study given South Africa's prominence in the HIV/AIDS epidemic, the significant presence of discordant couples and the South African government's commitment to HIV treatment and prevention efforts. Moreover, the South African Case Study establishes the feasibility of the recommendations and helps to identify barriers that need to be overcome. Finally, a discussion of future research needed is presented for further optimization of the proposed treatment as prevention strategy.Master of Public Healt