Serodiscordant Couples Profile

In a snapshot: in an interrupted relationship.

Serodiscordant couples (SDC) are those in which one partner is HIV-positive and the other is HIV-negative. Often, these couples are going through a period of disruption—trust issues, blame for bringing HIV into the relationship, disconnection about sex, and despair over the loss of intimacy. Many find themselves in the “discordance dilemma,” seeing no way to avoid HIV transmission while preserving their relationship. Even for those who remain loving and committed, the risk of HIV transmission can complicate the things they want and value with their partner. Importantly, discordance can create frustration and despair for couples who want to conceive children—a strong and prevalent desire, sometimes driven by a new sense of mortality.

SDC are not always recognized as a priority for HIV prevention interventions, but are a significant population. 

One analysis estimated that between 55 and 92 percent of new, heterosexually acquired HIV infections among adults occurred within serodiscordant marital or cohabitating relationships. Further, the common perception that the man is always the HIV-positive partner is not necessarily true; a 2016 USAID report showed that HIV-positive female partners may account for 30 to 40 percent of SDC across sub-Saharan Africa. 1 Additionally, SDC themselves may hold a fairly inaccurate perception of their risk for HIV—only about half of uninfected partners in the OPTIONS research considered themselves at-risk for HIV. 1

SDCs prioritize family—and children.

According to quantitative market research completed in Kenya in 2017 (OPTIONS research), SDC care about family, health, and financial independence; stability is a major motivator for them. The desire for children is often very strong; while SDC worry about HIV, and most couples are aware of both horizontal and vertical transmission risks, hopes for conception may supersede the risks. 2 For many SDC, the inability to conceive, the loss of intimacy and trust, and the fear of infection, loss of health, and early death conspire to create a serious relationship struggle. Many face the “discordance dilemma” and feel that their relationship has become impossible. 3

SDC are concerned about their health and interested in prevention. They may be overly focused on condoms as the only pathway to “safe sex,” despite inconsistent condom use. 

In the OPTIONS research, 66 percent of respondents reported being “very concerned about their health,” and 82 percent agreed emphatically with the idea that “prevention is better than cure.” 1

In that same vein, SDC prioritize “safe sex,” which they primarily define as using condoms. However, use of condoms may be inconsistent, due to a range of challenges including the desire to conceive children; the desire for intimacy in sex, which can lead couples to forgo condoms; and the influence of alcohol. Intimate partner violence is a further factor that may prevent women from being able to negotiate condom use. 4

Notably, almost no survey respondents considered PrEP as something that can help them practice “safe sex.”¹ This is a definite opportunity for communications—defining PrEP as a form of practicing safe sex may encourage uptake.

For couples, PrEP can be a powerful symbol of hope.

Awareness of PrEP may be quite high for this population—the OPTIONS research found that approximately three in four SDC were aware of PrEP. Yet only 55 percent these respondents were sure that PrEP would work, suggesting an important opportunity for further education. 1

Numerous benefits of PrEP may resonate with SDC on both a practical and emotional level: PrEP can make couples feel safer, and can serve as a backup when one of the partners refuses to wear a condom or in case of condom breakages.

PrEP can also symbolize a couple’s commitment to managing HIV through shared ownership and responsibility. It can be a way to reduce stress within a relationship, and even preserve a marriage. PrEP can be a powerful way for couples to reanimate their sex lives and draw closer together by reducing or eliminating the need for condoms.

“[PrEP] not only protects the HIV-negative partner but also helps many marriages to thrive. In the past, many marriages involving HIV serodiscordant couples collapsed. And another thing, it allows for conception.” 5

– Female partner in an SDC, Kenya  

A more detailed, comprehensive version of this audience profile, including the relationship between SDC and high-risk activities and sexual and reproductive health, can be downloaded here.

For a sample demand creation strategy and information on the best media and tactics to reach SDC, check out the Communications Fast Tracker.