**5. Barrier and facilitators to achieving 90-90-90 among serodiscordant couples**

The possibility of sero-discordant relationships are becoming more common, given the improved quality of life and higher life expectancy for people living with HIV [26]. It is therefore imperative to expand HIV prevention efforts that target sero-discordant couples in the effort to reach the 90-90-90 treatment goals.

In regard to HIV testing and counselling, evidence shows that many of the prevention strategies to reduce the risk of HIV transmission in couples are individual as opposed to couples based. HIV testing and counselling practices, thus far, have only included one partner and encouraged clients to invite their partners to test for HIV. It would be ideal to provide health care services and feasible prevention methods for couples as a unit as opposed to individuals. Furthermore, it is evident that services have been gendered to favour females (e.g. who receive antenatal care) who are perceived to be at greater risk and to whom routine testing is encouraged. It may be important to expand the scope of testing for HIV among men who access health facilities for other health services. It may be suggested that there be more emphasis placed on HIV testing among males and this may speak to a need for male-centred health facilities.

[3] Cluver LD, Orkin MF, Yakubovich AR, Sherr L. Combination social protection for reducing HIV-risk behavior amongst adolescents in South Africa. Journal of Acquired

Achieving 90-90-90: A Focus on Sero-Discordant Couples

http://dx.doi.org/10.5772/intechopen.78313

39

[4] Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, Labadarios D, Onoya D et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012.

[5] Zuma K, Shisana O, Rehle TM, Simbayi LC, Jooste S, Zungu N, et al. New insights into HIV epidemic in South Africa: Key findings from the national HIV prevalence, incidence

[6] Mashaphu S, Burns JK. Couples-based interventions in the context of HIV discordance.

[7] Kilembe W, Wall KM, Mokgoro M, Mwaanga A, Dissen E, Kamusoko M, et al. Knowledge of HIV serodiscordance, transmission, and prevention among couples in Durban, South

[8] Ndirangu G. Fertility and conception options for HIV-serodiscordant couples in Sub

[9] Wilton J. HIV prevention within serodiscordant couples: A changing paradigm. Prevention in Focus. Canada: Spring; 2015. Available: http://www.catie.ca/en/pif/spring-2015/

[10] Guthrie BL, De Bruyn G, Farquhar C. HIV-1-discordant couples in sub-Saharan Africa: Explanations and implications for high rates of discordancy. Current HIV Research.

[11] Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: An analysis of survey and clinical data. The Lancet. 2008;**371**(9631):

[12] Matthews LT, Crankshaw T, Giddy J, Kaida A, Smit JA, Ware NC, Bangsberg DR. Reproductive decision-making and periconception practices among HIV-positive men and women attending HIV services in Durban, South Africa. AIDS and Behavior. 2013;**17**(2):

[13] Eyawo O, De Walque D, Ford N, Gakii G, Lester RT, Mills EJ. HIV status in discordant couples in sub-Saharan Africa: A systematic review and meta-analysis. The Lancet Infec-

[14] Patel RC, Stanford-Moore G, Odoyo J, Pyra M, Wakhungu I, Anand K, Brown JM. "Since both of us are using antiretrovirals, we have been supportive to each other": Facilitators and barriers of pre-exposure prophylaxis use in heterosexual HIV serodiscordant couples in Kisumu, Kenya. Journal of the International AIDS Society. 2016;**19**(1):1-10

Saharan Africa. Finland: Arcada University of Applied Sciences; 2017

hiv-prevention-within-serodiscordant-couples-changing-paradigm

and behaviour survey, 2012. African Journal of AIDS Research. 2016;**15**(1):67-75

Immune Deficiency Syndromes (1999). 2016;**72**(1):96

South African Journal of Psychiatry. 2017;**23**:a1009

Africa. PLoS One. 2015;**10**(4):e0124548

tious Diseases. 2010;**10**(11):770-777

2007;**5**(4):416-429

2183-2191

461-470

Cape Town: HSRC Press; 2014

In relation to treatment as prevention for sero-discordance, it was found through various clinical trial in South Africa that adherence to using PrEP was a major barrier [29]. This therefore nullifies the excellence of the approach to safeguard the uninfected partner from the transmission of the virus. Furthermore, some of the pre-exposure prophylaxes technologies are yet to be tested. And therefore it is imperative that we explore strategies to increase adherence for ART for the positive partner, more importantly that we should uncover the barriers to adherence for PrEP utilisation.

There are barriers associated with family planning strategies for sero-discordant couples. These include the affordability and accessibility of intrauterine or intravaginal insemination technologies to aid in safe conception. Couples therefore have to rely on manual methods such as timed unprotected sex during fertile periods. This strategy requires health care workers and couples to be cautious and thorough in their actions, so as to reduce the risk of transmission.

Regardless of the existing literature on sero-discordant couples, there is still a need to conduct further research on treatment as prevention and sexual health services that are tailor-made for such couples.
