Risk factors for concordant HIV infection in heterosexual couples in Trinidad

Abstract

Risk factors for HIV infection in partners of HIV-seropositive index cases were investigated in a cross-sectional survey. Between September 1992 and April 1994 a total of 251 HIV-infected persons and 76 of their sexual partners were interviewed at the main sexually transmitted diseases (STDs) clinic in Trinidad. All participants gave signed consent and responded to a questionnaire. Sixty-four couples had risks for HIV infection through heterosexual intercourse only. However, many recruited sex partners (57/64) reported heterosexual intercourse with persons in addition to the index cases. Overall HIV concordance (both index case and partner HIV infected) was 45% in the couples. HIV concordance was not found to be related to the sexual practices within the studied unions nor to the clinical status of the index case. After allowing for confounding factors there was an increased risk for HIV concordance in couples in unions for > or = 1 year (adjusted OR 3.48; 95% CI 0.89-13.69, P = 0.055), and in those in which sex partners had a past history of genital sores (adjusted for prostitution: OR 4.50; 95% CI 1.01-20.4). Interventions targeted at reducing high-risk sexual behaviour, prostitution and cocaine use could be beneficial in reducing the spread of STDs and HIV in Trinidad.

PIP: A cross-sectional survey conducted at the main sexually transmitted disease clinic in Trinidad in 1992-94 investigated risk factors for concordant HIV infection in 251 HIV-infected persons and 76 of their sexual partners. Sexual contact with the index case was the only reported HIV risk factor for 7 partners; another 57 partners with heterosexual intercourse as the sole HIV risk factor reported intercourse with persons in addition to the index case in the preceding 5 years. Overall, HIV concordance was 45% (38% in couples with a female index case and 50% when the index case was male). HIV concordance was unrelated to either sexual practices within the studied unions (e.g., frequency of intercourse, condom use, male circumcision, sex during menstruation) or the current clinical status of the index case. After adjustment for confounding factors, there was an increased risk for HIV concordance among couples in unions for 1 or more years (adjusted odds ratio (OR), 3.48; 95% confidence interval (CI), 0.89-13.69) and those in which sex partners had a past history of genital sores (OR adjusted for prostitution, 4.50; 95% CI, 1.01-20.4). These findings suggest a need for policies to ensure that the sex partners of HIV-infected persons in Trinidad are notified, counseled, and offered HIV testing because of their elevated risk of infection.