Genital Abnormalities, Hormonal Contraception, and Human Immunodeficiency Virus Transmission Risk in Rwandan Serodifferent Couples

Abstract Background We explored the role of genital abnormalities and hormonal contraception in human immunodeficiency virus (HIV) transmission among heterosexual serodifferent couples in Rwanda. Methods From 2002 to 2011, HIV-serodifferent couples who were not using antiretroviral treatment were fo...

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Bibliographic Details
Published in:	The Journal of infectious diseases 2021-07, Vol.224 (1), p.81-91
Main Authors:	Wall, Kristin M, Karita, Etienne, Nyombayire, Julien, Ingabire, Rosine, Mukamuyango, Jeannine, Parker, Rachel, Brill, Ilene, Price, Matt, Haddad, Lisa B, Tichacek, Amanda, Hunter, Eric, Allen, Susan
Format:	Article
Language:	eng
Subjects:	Adult Antiretroviral drugs Birth control Contraception Disease transmission Dysbacteriosis Female Genital Diseases, Female - complications Gonorrhea HIV HIV Infections - epidemiology HIV Infections - etiology HIV Infections - transmission Hormonal Contraception - methods Human immunodeficiency virus Humans Immune system Major and Brief Reports Male Risk Factors Seroepidemiologic Studies Sexually Transmitted Diseases - complications Trichomoniasis Ulcers Vagina Vaginosis
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Summary:	Abstract Background We explored the role of genital abnormalities and hormonal contraception in human immunodeficiency virus (HIV) transmission among heterosexual serodifferent couples in Rwanda. Methods From 2002 to 2011, HIV-serodifferent couples who were not using antiretroviral treatment were followed up, and sociodemographic and clinical data were collected, family planning provided, and HIV-negative partners retested. Couples were assessed for genital ulcers; nonulcerative genital sexually transmitted infection (STIs), 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 in which the man was HIV positive, 37 linked transmissions occurred. Factors associated with women’s HIV acquisition included genital ulceration in the female partner (adjusted hazard ratio, 14.1) and nonulcerative STI in the male partner (8.6). Among 955 couples in which the woman was HIV positive, 46 linked transmissions occurred. Factors associated with HIV acquisition in men included nonulcerative STI in the female partner (adjusted hazard ratio, 4.4), non-STI vaginal dysbiosis (7.1), and genital ulceration in the male partner (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 (eg, cost of training, demand creation, advocacy, and client education; provider time; and clinic space) to joint HIV/STI testing need to be considered and addressed. Our findings underscore the need to improve integration of human immunodeficiency virus (HIV) services with care for genital inflammation, ulceration, and infection, which were associated with HIV risk. Hormonal contraceptive use was not associated with HIV risk in this study.
ISSN:	0022-1899 1537-6613