The Global Network of People living with HIV welcomes the release of the World Health Organization’s “Guidance on Couples HIV Testing and Counselling and Antiretroviral Therapy for Treatment (ART) and Prevention in Serodiscordant Couples: Recommendations for a public health approach”. The new Guidance recommends increased offering of HIV testing and counselling to couples, with support for mutual disclosure. Other recommendations include offering antiretroviral therapy (ART) for HIV prevention to HIV-discordant couples.

GNP+ supports the specific attention paid in the Guidance to the sexual and reproductive health and rights of serodiscordant couples. Following a study amongst HIV-discordant couples conducted in 2009[i], GNP+ concluded that the needs of HIV-discordant couples have received insufficient attention in the research and policy agenda.

“Most interventions for HIV prevention, treatment, care and support are directed at individuals and there are few interventions for couples,” says Anna Zakowicz, co-chair of GNP+, “The new Guidance starts to fill this gap in the public health policy environment.”

One of the other conclusions of the GNP+ study was that HIV-discordant couples should be more engaged in the HIV response. GNP+ is also enthusiastic that the Guidance was informed by real life experiences of people living with HIV in low and middle income countries and particularly in Sub-Saharan Africa.

With over 60% of people living with HIV unaware of their status[ii],  GNP+ strongly supports increased access to HIV testing and treatment, but reiterates the need that any such increase must be based on informed and voluntary choices of individuals.

Significantly, the Guidance recommends offering ART for the HIV-positive member of a HIV-discordant couple to help prevent HIV transmission to their negative partner. While GNP+ is excited that new evidence around the preventive effects of treatment is informing the development of global policy, GNP+ expresses caution about the operationalisation of this Guidance. The benefits and risks of starting ART at CD4 counts above 350 for the health of the individual living with HIV are currently unknown. Every person living with HIV, regardless of their medical need for ART, must be counseled on the health benefits and risks they can expect from starting ART, then as a secondary consideration, the preventive benefits and risks. This counseling should include information on the known short-term and long-term side effects, and the fact that not all these side-effects can currently be known due to ART comprising of relatively new medication.

Anuar Luna, Co-Chair of GNP+, states, ‘Our enthusiasm for HIV testing and ART for prevention must not undermine the individual needs and rights of people living with HIV to have access to all available information and support to enable us to make informed personal decisions to support our own health and wellbeing, and that of our partners’.