The focus of CHCT is that two or more people in a relationship come for services together, are counselled together and receive their HIV test results together. Couples counselling can be delivered in different sites within different models of existing counselling and testing services, such as VCT centres and during PMTCT sessions, among others.
In CHCT it is very important to emphasise and explain areas that are NOT widely understood, such as couple discordance. A discordant couple is one where one partner is HIV positive and the other is HIV negative. Discordance is common in countries with high prevalence of HIV. The HIV negative partners in discordant couples are at high risk for getting HIV if the couple does not take steps to protect the HIV negative partner. Preventing transmission within a discordant couple is one of the most critical reasons for offering couples HIV counselling and testing services.
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- The environment is safe for couple to discuss risk concerns.
- Partners hear information together, enhancing likelihood of a shared understanding and support.
- Counsellor has the opportunity to ease tension and diffuse blame.
- Counselling messages are based on the results of both individuals.
- Individual is not burdened with the need to disclose results and persuade partner to be tested.
- Treatment and care decision can be made together.
- Couple can engage in decision-making for the future.
- Individual testing leads to assumptions about partner’s HIV status.
- To contend with HIV and plan for their future, both partners must know their status.
- Before knowing their HIV status, most discordant couples do not use condoms; however, CHCT has been shown to increase condom use.
- In many cases, the couple enters the relationship when they are already discordant – discordance is NOT a sure sign of infidelity.
- Discordant couples are not protected by just remaining faithful; protective measures must be taken to prevent the uninfected from getting infected and helping the positive partner to live positively with HIV.
- Individual rates of disclosure are very low.