Prevention in Focus

Spring 2015 

Views from the front lines: Counselling serodiscordant couples

We spoke to three service providers to find their views and approaches to counselling serodiscordant couples:

  • Tsion Demeke Abate, Community Education Facilitator, HIV Edmonton, Alberta
  • Colm Holmes, Gay Men's Sexual Health Program Coordinator, AIDS Committee of Windsor, Ontario
  • Sandra Sasaki, Education Manager/ Positive Prevention Coordinator, Positive Living North, Prince George, BC

Tsion Demeke Abate

How often are you asked for information on how to reduce the risk of HIV transmission in a serodiscordant couple (where one person is HIV positive and the other is HIV negative)? What type of information are people looking for?

People come with questions related to serodiscordant relationships on average two to three times a week.

Most of our discussions revolve around proper use of prevention tools, testing of the partner who is not living with HIV, and general support and information on how to continue to reduce the risk of transmission.

Sometimes, serodiscordant couples discuss the stigma and discrimination they face when people tell the HIV-negative partner that they should be scared of contracting HIV from their HIV-positive partner.

What challenges do serodiscordant couples face?

For some, it is challenging when there is too much focus on fear of transmission, and as a result serodiscordant couples find it hard to fully develop their relationship. There is always the fear of infecting the HIV-negative partner or losing that partner all together.

There is stigma in many communities and some challenges come from family and friends who always seem to put the HIV-negative partner down and remind them that their partner is HIV positive, telling them, “You will get it soon, or your partner will get really sick and you’ll be taking care of them for a long time.” In addition, sometimes family and friends just assume that the HIV-negative partner is positive but does not want to disclose. In general, there is a profound lack of support for serodiscordant couples from family and friends.

What strategies can you share that you use to support serodiscordant couples to reduce their risk of HIV transmission?

I explain how HIV is transmitted as clearly as possible and encourage the use of proper prevention 100% of the time. I emphasize that condoms, when used consistently and correctly, work to reduce transmissions!

I encourage and support the HIV-positive partner’s adherence to medication because the risk of passing HIV is lower if the HIV-positive partner is taking medication and the medication is working for them. I also help them understand the viral load test result, since a lower viral load means the person is less likely to pass HIV to their partner.

I foster an open and honest communication about sex between partners.

I also discuss PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis) with them. I find that not a lot of people know or ask about PrEP. Regardless, I explain what PrEP is and how, in the U.S., PrEP could be made available for people who are HIV negative and are at a substantial risk of HIV infection and that serodiscordant couples are part of this group. I explain to them that when taken daily, PrEP offers good protection against HIV infection but is not 100% effective. In addition, it doesn’t protect against other sexually transmitted infections (STIs). I always lean toward a model of ”multiple layers of protection,” explaining that the HIV-negative person can protect themselves from HIV by taking the antiretroviral drug Truvada as PrEP consistently and also by using condoms consistently during sex for protection against other STIs.

Colm Holmes

How often are you asked for information on how to reduce the risk of HIV transmission in a serodiscordant couple (where one person is HIV positive and the other is HIV negative)? What type of information are people looking for?

Personally, I am seldom asked by serodiscordant couples (mixed couples) for information on how to reduce the risk of HIV transmission. As a gay men’s sexual health coordinator, I deal with gay men and they typically ask for information around risk reduction strategies more generally. Many of these strategies would be useful for guys in a serodiscordant relationship too.

People are looking for information about PrEP (pre-exposure prophylaxis) or for research information that is relevant to them like the Partner study, which showed that treatment can act as a prevention tool.

From my experience, most serodiscordant couples do research on their own to gain a better understanding of the challenges they face and come to me with specific questions around reduction strategies. Even with the internet, there are barriers to the accessibility of up-to-date information on the best ways to reduce risk.

What challenges do serodiscordant couples face?

Serodiscordant couples may lack the support of their families or friends with regards to their relationship. Additionally, some HIV-positive individuals may fear giving their partner HIV; HIV-negative partners may fear stigmatizing the individual they love.

Mostly, I think gay men in serodiscordant relationships face the same challenges as other couples do, with HIV being an additional challenge.

What strategies can you share that you use to support serodiscordant couples to reduce their risk of HIV transmission?

There are several strategies serodiscordant couples can use to reduce risk. For example, we know treatment as prevention is an effective way to reduce risk; as well as PrEP, which the HIV-negative partner can use to reduce risk. PEP (post-exposure prophylaxis) is another tool that the HIV-negative partner can use if they think they may have been exposed to HIV. Proper condom use is also a method that can be very effective. Finally, there is strategic positioning, where the HIV-positive individual is the receptive partner during anal sex and that reduces some of the potential risk of transmitting HIV.

Serodiscordant couples need guidance on the effectiveness of these strategies alone and in combination. I encourage these couples to have open and honest conversations with their HIV specialist as they can be a great source of information with regards to reducing risk.

Sandra Sasaki

How often are you asked for information on how to reduce the risk of HIV transmission in a serodiscordant couple (where one person is HIV positive and the other is HIV negative)? What type of information are people looking for?

I am not often asked about HIV transmission in a serodiscordant couple as, more often than not, the couple knows to use a condom when engaging in sex and if they are using drug equipment then they know to use their own.

If a couple wants to conceive a child, I talk about the positive person’s viral load and its impact on the possibility of HIV transmission, but encourage them to discuss this with their doctor to ensure there is minimal transmission risk to both the HIV-negative person and the baby.

What challenges do serodiscordant couples face?

The challenges that serodiscordant couples face can be similar to the challenges that other people living with HIV face. In our community these challenges include poverty and addictions. An added challenge for serodiscordant couples is the stigma and discrimination they face from others who feel they should not be together because one of them lives with HIV.  

What strategies can you share that you use to support serodiscordant couples to reduce their risk of HIV transmission?

We talk to individuals and their partners about the risk of condomless sex or sharing drug use equipment. Positive Living North has condoms readily and easily accessible. I am also open to talking about PrEP (pre-exposure prophylaxis), should clients want to talk about that, but this has not taken place at this point. I encourage the couple to have an open dialogue with their doctor to make sure they can talk to them about being in a serodiscordant couple.

Related article

For more detailed information on serodiscordant couples, see HIV prevention within serodiscordant couples: A changing paradigm.