Discordance: Mystery or miracle?

Rwanda has been active in the fight against the HIV/Aids scourge. According to the 2005 Demographic and Health Survey, HIV prevalence in Rwanda was at three per cent, with 2.2 per cent in the rural areas and 7.3 per cent in the urban areas. A survey carried out by Project San Francisco on heterosexual transmission in Rwanda states that there have been increased cases of infections especially between married couples. The result also shows that there has been an increase in infections from 55.1 per cent to 91.7 per cent among discordant married couples and those cohabiting. Discordant couples are those in a sexual relationship whereby one has a sexually transmitted infection and the other does not. The cause of this condition has not yet been identified but some say it’s a miracle while some people claim it is temporarily resistance to the infection. Dr Florence Mukakabano Gasatura, Director of Nursing at Kigali National Hospital says there is no scientific reason that explains discordance and that the safe partner is only protected by the grace of God. Discordance has its challenges and its strain on couples and usually strains marriages and relationships.Couples tend to blame each other on receiving the news and don not understand why one was spared. There is the fear of HIV transmission to the partner not infected and the fear of coping with uncertainty of potential illness. Couples are advised to go for counselling to cope with this challenging scenario. Through counselling, couples are advised to use condoms for protection and to try abstaining in case the infected partner has full blown Aids. “Discordant couples need counselling to understand the situation and we usually advise them to use condoms or abstain from sex if they can,” Dr Mukakabano reiterated. She further adds that discordance affects reproduction in relationships because the process is detrimental to one of the partners. In cases where a couple really wants to have a baby, they are referred to a gynaecologist with whom they can discuss their options. There are also some anti- retro viral drugs that can be given to the uninfected partner in order to protect them, but these are not 100 per cent reliable and one still stands a chance of being infected. Identification of HIV discordant couples is important in the prevention of transmission and prevalence of the scourge. Despite repeated counselling on behaviour change and risk reduction, some couples continue to engage in high risk behaviour that ends up risking their healthy partners. Jacksotum@yahoo.com