Abstract
Background
We explored the role of genital abnormalities and hormonal contraception in HIV transmission among heterosexual serodifferent couples in Rwanda.
Methods
From 2002-2011, non-antiretroviral treatment using HIV serodifferent couples were followed and sociodemographic and clinical data were collected, family planning provided, and HIV-negative partners retested. Couples were assessed for genital ulcers; non-ulcerative genital sexually transmitted infection (STI) including gonorrhea, chlamydia, and trichomoniasis; and non-STI vaginal infections including bacterial vaginosis and candida. Multivariable models evaluated associations between covariates and HIV transmission genetically linked to the index partner.
Results
Among 877 couples where the man was HIV-positive, 37 linked transmissions occurred. Factors associated with women’s HIV acquisition included female partner genital ulceration (adjusted hazard ratio [aHR]=14.1) and male partner non-ulcerative STI (aHR=8.6). Among 955 couples where the woman was HIV-positive, 46 linked transmissions occurred. Factors associated with men’s HIV acquisition included female partner non-ulcerative STI (aHR=4.4), non-STI vaginal dysbiosis (aHR=7.1), and male partner genital ulceration (aHR=2.6). Hormonal contraception use was not associated with HIV transmission or acquisition.
Conclusions
Our findings underscore the need for integrating HIV services with care for genital abnormalities. Barriers (e.g., cost for training, demand creation, advocacy, client education; provider time; clinic space) to joint HIV/STI testing need to be considered and addressed.
Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women