Ending AIDS by 2020? The Necessary Steps in Sub-Saharan Africa
For a few seconds, imagine that you are a 25 year-old male living in a capital city anywhere in the world. You have never been tested for HIV, but you are both curious and apprehensive about your status. You have no idea what testing is like. One day, a colleague refers you to a testing clinic. After much debate and discussion, you finally decide to go. Once you arrive at the clinic, a trained and qualified counselor welcomes you and begins to counsel you on a variety of topics. The topics range from your beliefs and knowledge about HIV to performing an individual assessment of your risk. This discussion allows you to make an informed decision about getting tested, and you decide to proceed. After a few minutes, your results are ready. You are once again counseled privately about your results and its implications.
This process — known as Voluntary Counseling and Testing (VCT) for HIV — has become increasingly vital in the fight and prevention of HIV/AIDS worldwide, particularly in communities where the disease is widespread. VCT was originally implemented as an individual-level, clinic-based procedure. It has since expanded, with sessions being provided at clinics or through other community-based initiatives. When tailored towards couples, the VCT approach is referred to as Couples Voluntary Counseling and Testing (CVCT). CVCT has proven to be vital in the prevention of HIV/AIDS transmission from partner to partner.

Currently, the vast majority of individuals living with HIV are in low- and middle-income countries. Sub-Saharan Africa is the most affected region, with an estimated 26 million people living with HIV in 2015. East and Southern Africa are two of the hardest hit regions. Residents of these regions comprise only six percent of the world’s population but half of all people living with HIV. The majority of new HIV infections in sub-Saharan Africa are acquired within cohabiting heterosexual partnerships. Close to two-thirds of total HIV incidence in sub-Saharan Africa occurs among stable couples, with half of this incidence attributed to HIV transmissions from the infected to the uninfected partner in the couple.
I am a Global Health Corps fellow currently placed at Zambia-Emory HIV Research Project (ZEHRP), an organization under the Rwanda Zambia HIV Research Group (RZHRG) in Lusaka, Zambia. RZHRG has been a global leader in the fight against HIV/AIDS for more than 30 years, supporting various research and prevention programs. ZEHRP is committed to supporting Couples Voluntary Counseling and Testing (CVCT) as an effective and economical way to decrease HIV/AIDS transmission throughout Southern Africa.
Eighty percent of all sexually transmitted HIV infections in Zambian women and 60 percent in Zambian men are acquired in marriage or cohabiting partnerships. According to the World Health Organization (WHO) and the President’s Emergency Plan for AIDS Relief (PEPFAR), joint HIV testing and counseling for couples together reduce new infections by more than two-thirds.
Various studies (which have not yet been published) conducted by ZEHRP indicate that CVCT is an effective method for reducing the incidence of HIV infections among couples. For example, the impact of CVCT activities coordinated by ZEHRP across seven Zambian cities from September 2010 to June 2015 was evaluated. 173,522 Zambian couples received joint voluntary HIV counseling and testing in 70 government clinics. Results indicate that there was a 78 percent reduction in HIV transmission after CVCT among discordant couples — couples where one partner is HIV positive and the other HIV negative.

Heterosexual couples are one of the largest risk groups urgently in need of effective HIV prevention in sub-Saharan Africa. Yet, most HIV prevention programs in this part of the world have been vertical and focused on the individual. CVCT allows couples to discuss their current HIV status, get tested, and discuss a plan for prevention together, but access to CVCT services remains low, with the main challenge being limited funding to train counselors and roll out initiatives.
The evidence clearly supports broad implementation of CVCT as a primary method of HIV prevention and transmission. Governments, bilateral, and multilateral funding agencies must jointly prioritize CVCT for the prevention of new HIV infections. Through such efforts, our global community can move one step closer to realizing the promise of an AIDS-free generation in our lifetimes.
Titilope Akinlose is a 2016–2017 Global Health Corps fellow at the Zambia-Emory HIV Research Project (ZEHRP) in Lusaka, Zambia.

