Patterns in HIV Serodiscordance among Couples in Sub-Saharan Africa: Evidence from Ten High-Prevalence Countries

Sarah E. Staveteig, Demographic and Health Surveys
Thomas W. Pullum, Demographic and Health Surveys
Shanxiao Wang, Demographic and Health Surveys

HIV-1 serodiscordance—one partner HIV-positive, the other HIV-negative—is widespread among couples in sub-Saharan Africa, putting millions of uninfected partners at high risk of HIV infection. To date, most analyses of cross-national patterns in couple discordance have failed to factor into account the underlying statistical predictability of observed patterns. Using data from recent Demographic and Health Surveys and AIDS Indicator Surveys in ten countries with HIV prevalence above 4%—Cameroon, Kenya, Lesotho, Malawi, Mozambique, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe—we introduce metrics of joint HIV status that account for underlying gender differences in HIV prevalence. Using these metrics, we analyze couples' shared and individual characteristics that may be associated with unusual differentials between observed and expected HIV status. Overall, we find that observed gender imbalances in HIV discordance among couples in these ten countries appear to be driven solely by underlying gender differences in HIV prevalence.