Memoire Online - Prevalence of hiv infection and factors associated with discordant couples receiving hiv test in Gasabo district

SCHOOL OF PUBLIC HEALTH
DEPARTMENT OF COMMUNITY HEALTH AND SCIENCE
MASTER OF PUBLIC HEALTH
DISSERTATION

Prevalence of HIV Infection and Factors Associated with Discordant Couples Receiving

Done by
HABAKUBAHO DESIRE
Reg.N^O: 222000904
Supervisor: Ass. Prof. Lawrence RUGEMA
Co-Supervisor: Dr. SIMBI Clarisse Marie Claudine

I would love to thank the college of Rwanda, the university of medication and health Sciences,

ABSTRACT

Introduction: HIV-discordant couples, where one partner is infected and the other is not, face significant risks of HIV transmission within stable relationships. In Rwanda, despite a low overall HIV prevalence of 3% and limited data on HIV-discordant couples, understanding and addressing the specific challenges faced by these couples is crucial for advancing HIV prevention efforts. This study examined the Prevalence of HIV infection and associated factors among discordant couples who received HIV tests at Kibagabaga Hospital.

Methods: Using a case study approach, the research involves 254 discordant couples who went into HIV testing services from 2020 to 2024, and they were recruited through purposive sampling. Data collection includes patient interviews and questionnaires, with subsequent statistical analyses to identify prevalence and risk factors.

Results: Between 2020 and 2024, the overall HIV prevalence remained at 50% while stratifying in years of 127 cases positive, in 2020 was 18.1, and in 2022 was 31.5%, and in 2024 was 13.4%. HIV prevalence over the years kept changing where in 2020 significant associations with HIV infections including multiple sexual partners (OR: 6.7, 95%CI:2,4-10.30), Age of >45 years (OR: 2.3, 95%CI: 1.1, 5.12), and Occupation, Driver (OR: 4.77,95%CI: 1.71, 13.31).

Keywords: Prevalence HIV-Discordant Couples, HIV Infection, HIV Testing, Risk Factors.

4.4. Logistic regression of the associated risk factors of HIV infection among the

Table 2: shows the socio-demographic characteristics and HIV infection among discordant couples

Table 3 shows the primary characteristics and HIV infection among discordant couples 35

Table 4: Logistic regression of the associated risk factors of HIV infection among the discordant

Figure 1:Conceptual framework on the prevalence of HIV discordance and associated risk

HIV-discordant couples could benefit from such measures to help suppress the HIV viral load of the affected companion and decrease the hazard of HIV transmission to at least 60% (Temam & Ali, 2012) HIV-discordant couples make a contribution the highest to HIV infections in Africa, serving as a chance to sound fitness for themselves and their companions if now not well managed. that is usually now not continually possible due to the fact maximum discordant companions keep their status away from their partners for different reasons. young human beings who've intentions of having married to their friends who aren't superb might face special demanding situations.

couples who acquired the disease during marriage worry being stigmatized, deserted, or violated, by their terrible companions once their repute is understood. most of these have an effect on the mental stories of HIV-discordant couples in extraordinary ways (Bunnell et al., 2005).

In Tanzania, an HIV and AIDS population-primarily based survey confirmed that a number of the couples inside the cutting-edge union, ninety 3% have been HIV concordant negative, 2% have been HIV concordant first-rate even as five% have been HIV discordant; while in three% of sero-discordant relationships, guys companion come to be infected and the women were no longer. In most instances, the proportion of inflamed ladies and men in the ones relationships is form of similar (Natchu et al., 2012).

In Rwanda, HIV incidence is the bottom in Africa and there may be limited records on HIV-discordant couples which may also cause a paucity of critical facts important to improve international HIV desires. For greater than 15 years nowadays, the prevalence of HIV in the entire populace in Rwanda has remained at 3%, on the equal time as the disease occurrence amongst couples in Rwanda is 2.9% (Nsanzimana,2019). however the presence of this population, there is a paucity of records within the literature approximately HIV-discordant couples. it's far in opposition to the above background that this test goals to have a have a look at the prevalence of HIV discordance and related threat elements among couples receiving HIV test so as to reveal records as a manner to be useful in supporting the lives of sero-discordant couples and commonly human beings residing with HIV.

the general public of couples are blind to their reputation or presume to have the same repute as that in their partners (HIV attempting out with the aid of proxy), which also refers to estimating an character's HIV repute primarily based on the appeared HIV fame in their sexual associate, in preference to direct trying out. This technique is regularly utilized in population-based research where trying out each person is impractical, however it is able to bring about inaccuracies because of functionality discordance between partners' HIV statuses.

In Rwanda, no matter improvements in HIV prevention and remedy, HIV infections amongst couples remains a e4028a5c6dae3ad5086501ec6f3534d0 undertaking. besides, discordant couples, in which one accomplice is HIV- 86f68e4d402306ad3cd330d005134dac at the same time as the alternative is HIV-horrible, face particular demanding situations in handling their fitness and stopping transmission. despite the importance of understanding the superiority and determinants of HIV contamination in couples, there is an opening within the present literature regarding its prevalence and related hazard factors among couples undergoing HIV trying out (Nsanzimana, 2019)

This look at goals to address this gap via the usage of investigating the prevalence of HIV infections and discordance and identifying the danger elements associated with them amongst couples receiving HIV finding out offerings in Gasabo district, due to the reality this location has a sizeable metropolis populace with a excessive incidence of HIV discordant couples. furthermore, Gasabo district has accessible healthcare centers and a diverse demographic, providing a consultant pattern for statistics the superiority of HIV infections, discordance and associated danger factors in an town placing. by the use of information the quantity of infections and discordance in couples, and the factors contributing to them, interventions can be tailored extra efficiently to reduce transmission risk and enhance the overall health effects of each companions.

1.3.1 To the researchers

This have a take a look at will help researchers make contributions know-how to the field of HIV/AIDS epidemiology and public fitness, as it will fill gaps in present literature, presenting a higher understanding of the prevalence of HIV discordance and its determinants amongst couples present process HIV trying out.

1.3.2 To the University

The study and its findings will help the students and academics of the university in carrying out further investigation into HIV discordance in married couples. The have a look at might be some of the pool of different research studies performed at the college degree.

1.3.3 To the policymakers

research findings could have implications for policy improvement and implementation at neighborhood, national, and global degrees.

formulate regulations aimed toward enhancing HIV checking out uptake among couples, improving get entry to to prevention and treatment offerings, and addressing unique danger elements associated with HIV

1.3.4 To the community

The study findings will help raise awareness within the community about the risks associated with HIV discordance and the importance of HIV testing, particularly for couples. Increased awareness will lead to more proactive health-seeking behaviors, including regular HIV testing and engagement in preventive measures. Understanding the prevalence and risk factors associated with HIV discordance can inform targeted interventions aimed at reducing HIV transmission rates within the community. By identifying high-risk groups and addressing specific risk factors, interventions can be tailored to effectively prevent HIV infections and reduce the overall burden of the disease.

1.4 Study objectives 1.4.1 Main objective To determine the HIV infection and associated risk factors among discordant couples receiving HIV tests in Gasabo District.

? To determine the prevalence of HIV infections among discordant couples who received HIV tests in Kibagabaga Hospital from 2020 to 2024.

? To determine sociodemographic, behavioral, clinical, psychological, and relationship factors associated with HIV prevalence among couples who received HIV tests in Kibagabaga Hospital from 2020 to 2024.

? To determine the association between HIV Infection and sociodemographic, behavioral, clinical, psychological, and relationship factors among discordant couples who received HIV tests in Kibagabaga Hospital from 2020 to 2024.

Chapter one, is the introduction, in which the researcher introduces the topic of the research, provides background information, states the research question or hypothesis, outlines the objectives, and explains the significance of the study.

Chapter two of the literature review: in which the researcher surveys existing literature relevant to the research topic, discusses key theories, concepts, and findings, identifies gaps in the literature, and justifies the need for your study.

Chapter three was been of the methodology, in which the researcher described the research design, methods, and procedures used to collect and analyze data. Include information on participants, materials, instrumentation, data collection techniques, and data analysis methods.

Presents and analyzes the data you've collected, using tables, charts, and graphs. It summarizes the key results and their implications.

Chapter Five: Discussion Interpret the results in the context of your research questions and previous studies, discuss their theoretical and practical implications

Chapter six. conclusion and recommendations; acknowledge limitations, suggest future research,

2.1 Theoretical-literature-review

Social Cognitive Theory (SCT) provides a comprehensive framework for understanding the behaviors, dynamics, and outcomes within HIV-discordant couples. Through its emphasis on the interplay of individual cognitive processes, social influences, and environmental factors, SCT offers valuable insights into the complexities of HIV-related behaviors and the mechanisms through which they are shaped within the couple dyad (Bandura, 1998).

According to SCT underscores the importance of individual agency and self-efficacy in shaping HIV-related behaviors within couples. Partners' beliefs in their ability to successfully engage in preventive behaviors, such as condom use negotiation and adherence to medication, play a critical role in reducing HIV transmission risk. Interventions aimed at enhancing self-efficacy through skills-building, empowerment, and positive reinforcement can empower HIV-discordant couples to take proactive steps to protect their health (Islam et al., 2023)

SCT highlights the influence of social context and support networks on HIV-related behaviors within couples. Partners' perceptions of social norms, the availability of social support, and the quality of their interpersonal relationships can significantly impact their decisions regarding HIV testing, disclosure, and prevention practices.

Interventions that strengthen social support networks, foster open communication, and reduce stigma within communities can create an enabling environment for HIV-discordant couples to seek support and access necessary resources (Islam et al., 2023).

SCT emphasizes the role of observational learning and modeling in shaping HIV-related behaviors within couples. Partners may learn from each other's behaviors, attitudes, and coping strategies, influencing their own HIV prevention and management practices. Interventions that promote positive role modeling, encourage open communication, and facilitate shared decision-making can enhance couples' ability to effectively manage HIV risk and navigate challenges together (Li et al., 2014) .

SCT acknowledges the impact of structural barriers and systemic inequities on HIV-related behaviors and outcomes within couples. Socioeconomic inequalities, discrimination, and legal policies can create barriers to accessing HIV testing, treatment, and support services, particularly for marginalized populations. Addressing structural barriers requires multisectoral approaches that address underlying social determinants of health, promote health equity, and advocate for policies

that ensure equitable access to HIV care and support services for all couples (Bandura, 1994). According to (W. LaMorte MD, PhD, MPH, 2019) Social Cognitive Theory offers a nuanced understanding of the cognitive, social, and environmental factors influencing HIV-related behaviors within HIV-discordant couples. By applying SCT principles in research and intervention efforts, stakeholders can develop tailored strategies to promote HIV prevention, enhance communication and support within couples, and address systemic barriers to HIV care and treatment, ultimately improving the health and well-being of affected couples and communities (Bandura, 1994

2.2 Theoretical review

In a study by Waruiru et al. (2014) on factors associated with HIV discordance among couples in Kenya, data from the 2012 Kenya AIDS Indicator Survey (KAIS) were analyzed. This population-based survey included individuals aged 18 months to 64 years, collecting demographic and behavioral information along with blood samples for HIV testing. The analysis focused on married or cohabitating couples with available HIV test results for both partners. Logistic regression was used to identify factors associated with HIV discordance, selecting variables with a p-value of 0.10 or lower in bivariate analyses for the final multivariable model. The analysis accounted for the sampling design and non-response, with population estimates of HIV discordant couples calculated using un-normalized survey weights.

Out of a total of 4,226 couples, 2,032 couples (which is 48.1%) completed both interviews and HIV tests. Among these tested couples, the majority, 92.0% (1,870 couples), had both partners testing HIV-negative, indicating they were HIV concordant. A smaller percentage, 3.2% (65 couples), had both partners testing HIV-positive, meaning they were also HIV concordant but with both partners positive. The remaining 4.8% (97 couples) were HIV discordant, meaning one partner was HIV-positive while the other was HIV-negative. This proportion of discordant couples translates to approximately 260,000 couples in the broader population.

2.4 Conceptual-framework

Figure 1:Conceptual framework on the prevalence of HIV discordance and associated risk factors among couples receiving HIV test (Source: The researcher, 2024)

3.1 Studysetting

The study was conducted in Kibagabaga Hospital, located in Gasabo District. Kibagabaga Hospital is a prominent healthcare facility providing a wide range of medical services to the local population and is well-regarded for its commitment to improving public health. The Hospital has a comprehensive program for HIV testing and treatment, making it an ideal setting for this research. Gasabo district, situated in Kigali, the capital city of Rwanda, has a diverse population with varying socioeconomic backgrounds, providing a rich context for investigating the prevalence of

3.2 Research design

This approach provided empirical evidence to inform targeted interventions aimed at reducing HIV transmission among couples in the Hospital setting.

3.3 Study population

According to Sparks & Joyner (2019), a population is the total collection of elements about which we wish to make inferences. The target population in this study was comprised of 96 discordant couples who attended Kibagabaga Hospital of Gasabo District, during the period of 2020-2024.

3.4 Sample size

Records from Kibagabaga Hospital showed a total number of 696 discordant couples from 2020 to 2024. N

Formula for determination of Sample Size, n (Yamane, 1967); Where: n= the sample size

3.5 Sampling technique

All participants have been selected from Kibagabaga Hospital. systematic random sampling was used to sample the discordant couples who tested for HIV, and all of them had an equal chance to participate in the study.

- Couples affected by HIV discordance: The study included couples where one partner is HIV-positive (index case) and the other is HIV-negative.

- Residence in Gasabo District: Participants must reside within the Gasabo District to ensure the study's focus on this specific urban setting.

- Willingness to participate: Couples who expressed willingness to participate in the study through informed consent processes.

- Age criteria: Depending on study objectives, specific age ranges (e.g., 18-49 years) may be included to capture relevant age-related dynamics.

- Non-consenting couples: Couples who do not provide informed consent to participate in the study.

- Couples not meeting discordance criteria: Couples where both partners are HIV-positive or both partners are HIV-negative would be excluded.

- Residence outside Gasabo District: Couples residing outside Gasabo District would not be included to maintain geographical focus.

These criteria are essential for ensuring the study's relevance and integrity, focusing on the specific population of interest and enabling researchers to draw meaningful conclusions about HIV discordance within the targeted urban context of Gasabo district.

3.8 Data Analysis

This analysis plan was structured to meticulously investigate the impacts of socio-demographic, behavioral, clinical, psychosocial, and relationship factors on HIV outcomes. The process started with rigorous data cleaning to address missing data, outliers, and inconsistencies. Descriptive analysis followed, providing a detailed understanding of the dataset through frequency distributions, summary statistics, and visualizations of social demographics variables. In addition, Bivariate analysis identified significant associations between each variable and HIV status using chi-squared tests where statistical significance was measured at p-value <0.05. The study culminated in multivariate logistic regression models that assessed the combined effects of significant predictors while adjusting for confounders. The study reported adjusted odds Ratio, 95% CI, and p-value.

3.9 Ethical-considerations

A clearance letter turned into-received from the ethical research Committee of the college of Rwanda faculty of Public fitness. Permission become sought from the Gasabo district by way of providing the clearance letter from the faculty to get records from Kibagabaga clinic. informed consent become requested from all the research participants using an informed consent form signed with the aid of each participant. individuals who felt uncomfortable have been allowed to withdraw at any moment throughout the records series system without any penalty. information

changed into treated with utmost confidentiality the use of numbers as opposed to names and confined get entry to to data by non-researchers.

Table 1 illustrates the socio-demographic characteristics of a population of 254 individuals, highlighting distinct trends across various demographic markers. In gender distribution, males are predominantly represented with 165 (65%) compared to females who account for 89 (35%). The age group 26-35 years comprises the largest segment at 71 (28%), emphasizing a younger adult population. Educationally, the highest completion is at the university level with 71 (28%), showing a significant presence of higher education within the group. Occupation-wise, salaried positions lead at 58 (22.8%), reflecting a substantial portion of the population in formal employment. Religious affiliations are diverse, with Catholics being the most prevalent at 69 (27.2%). (see table 1)

Variable(s)	Number(n)	Percentage (%)
Gender
Female	89	35
Male	165	65
Age in years
18-25	68	26.8
26-35	71	28
36-45	52	20.5
>45	63	24.8
Education
A'level	56	22
O'level	57	22.4
Primary school	70	27.6
University level	71	28
Occupation
Business	41	16.1
Casual labor	44	17.3
Driver	36	14.2
Motorist	38	15

Figure 2 shows the HIV Prevalence among discordant couples, in 2020 it was 18.1%, while in 2021 was 13.4%, in 2022 was 31.5%, in 2023 was 23.6% and in 2024 was 13.4%.

4.2. Bivariate analysis of socio-demographic characteristics and HIV infection among discordant couples

The bivariate analysis of socio-demographic characteristics and HIV infection among discordant couples highlights two significant associations. First, age appears to play a critical role in infection rates, particularly among those over 45 years, where 41 individuals (65.1%, p-value = 0.0052) tested positive, suggesting a higher vulnerability to HIV infection. Secondly, occupation, specifically for

drivers, is associated with a markedly higher rate of HIV positivity, with 25 drivers (69.4%, p-value = 0.0167) being infected. (See table 2)

Table 2: shows the socio-demographic characteristics and HIV infection among discordant

*couples*
		HIV Status
	Negative	Positive
Variable(s)	No(row%)	No(row%)	P-Value
Gender			0.895
Female	44(49.4)	45(50.6)
Male	83(50.3)	82(49.7)
Age in years			0.0052
18-25	37(54.4)	31(45.6)
26-35	40(56.3)	31(43.7)
36-45	28(53.8)	24(46.2)
>45	22(34.9)	41(65.1)
Education			0.547
A'level	25(44.6)	31(55.4)
O'level	26(45.6)	31(54.4)
Primary school	39(55.7)	31(44.3)
University level	37(52.1)	34(47.9)
Occupation			0.0167
Business	25(61)	16(39)
Casual labor	24(54.5)	20(45.5)
Driver	11(30.6)	25(69.4)
Motorist	19(50)	19(50)
No occupation	19(51.4)	18(48.6)
Salaried	29(50)	29(50)
Religion			0.254

Table 3 provides a detailed exploration of primary characteristics and their correlation with HIV infection among discordant couples, highlighting several significant associations. Notably, engaging in transactional sex shows a marginally significant correlation with HIV positivity, with 39 individuals (51.3%, p-value = 0.0471) being positive, suggesting the potential risk associated with such behavior. A more pronounced risk is observed among those with multiple sex partners, where those without multiple partners exhibit a higher infection rate of 75 (57.3%, p-value = 0.017), underscoring the importance of limiting sexual partners in reducing HIV transmission. Additionally, a diagnosis with STIs also correlates with a higher HIV infection rate, with 77 positive cases (53.5%, p-value = 0.0205), highlighting the critical link between STI management and HIV risk reduction. Furthermore, relationship type emerges as a significant factor; individuals in monogamous relationships have an unexpectedly higher rate of HIV infection, at 67 (55.4%, p-value = 0.0102), indicating that even monogamous setups among discordant couples carry substantial transmission risks. (See Table 3)

Table 3:shows the primary characteristics and HIV infection among discordant couples

		HIV Status
	Negative	Positive
Variable(s)	No(row%)	No(row%)	P-Value
Transactional Sex			0.0471
Always	37(48.7)	39(51.3)
Condom use	30(50.8)	29(49.2)
Never	29(44.6)	36(55.4)
Sometimes	31(57.4)	23(42.6)
Multiple Sex			0.017


No	56(42.7)	75(57.3)
Yes	71(57.7)	52(42.3)
Sex Under
Influence			0.706
No	68(51.1)	65(48.9)
Yes	59(48.8)	62(51.2)
Diagnosis with
STIs			0.0205
No	60(54.5)	50(45.5)
Yes	67(46.5)	77(53.5)
Attended PrEP and PEP			0.38
No	68(52.7)	61(47.3)
Yes	59(47.2)	66(52.8)
Access to HIV
Services			0.166
No	74(54)	63(46)
Yes	53(45.3)	64(54.7)
HIV-related
Stigma			0.802
No	64(49.2)	66(50.8)
Yes	63(50.8)	61(49.2)
HIV Status Communication			0.954
Not discussed at all	25(50)	25(50)
Open and frequent	30(54.5)	25(45.5)
Rarely discussed	27(49.1)	28(50.9)
Somewhat open	23(46.9)	26(53.1)
partner	22(48.9)	23(51.1)
Depression Due to HIV Status			0.98
Always	28(50.9)	27(49.1)
Never	33(50.8)	32(49.2)
Rarely	32(47.8)	35(52.2)

	34(50.7)	33(49.3)
Length			0.765
1 to 2 years	32(51.6)	30(48.4)
6 months to 1 year	36(50.7)	35(49.3)
Less than 6 months	27(44.3)	34(55.7)
More than 2 years	32(53.3)	28(46.7)
Relationship Type			0.0102
Casual	73(54.9)	60(45.1)
Monogamous	54(44.6)	67(55.4)
Relationship Satisfaction			0.0523
Neutral	65(47.1)	73(52.9)
Very satisfied	62(53.4)	54(46.6)

4.4. Logistic regression of the associated risk factors of HIV infection among the discordant couples

Table four presents a logistic regression analysis of hazard factors for HIV infection among discordant couples, that specialize in adjusted odds ratios (AOR) and their significance. significantly, people over forty five years antique exhibit significantly higher odds of infection, with an AOR of 2.37 (95% CI: 1.10-five.12, p-price = 0.027), highlighting age as a essential issue in HIV susceptibility. similarly, drivers face a markedly multiplied danger, with an AOR of 4.seventy seven (ninety five% CI: 1.seventy one-thirteen.31, p-price = zero.003), pointing to occupational risks that contribute to HIV risks. moreover, having multiple sex partners drastically elevates HIV contamination odds, with an AOR of 1.67 (95% CI: 1.31-2.88, p-price = 0.016). (see table four)

Table 4: Logistic regression of the associated risk factors of HIV infection among the discordant couples

HIV Outcome	COR (95%CI)	P-value	AOR (95%CI)	P-Value
Age in years
18-25	1.00		1.00
26-35	1.83(1.35,1.90)	0.018*	0.93(0.45,1.90)	0.85
36-45	1.12(0.47,2.31)	0.909	1.02(0.47,2.21)	0.949
>45	2.37(1.12,6.12)	0.033*	2.37(1.10,5.12)	0.027*
Occupation
Business	1.00		1.00
Casual labor	1.37(0.59,3.65)	0.299	1.47(0.59,3.65)	0.399
Driver	4.03(1.71,13.01)	0.013*	4.77(1.71,13.31)	0.003*
Motorist	2.22(0.82,5.42)	0.123	2.12(0.82,5.52)	0.12
No occupation	1.37(0.61,4.17)	0.357	1.57(0.61,4.07)	0.347
Salaried	2.63(0.85,5.76)	0.179	2.03(0.85,4.86)	0.109
Transactional sex
Never	1.35(0.61,2.55)	0.635	1.25(0.61,2.56)	0.535
Sometimes	1.68(1.32,1.83)	0.0314*	0.68(0.32,1.43)	0.314
Condom use	1.02(0.49,2.11)	0.945	1.02(0.49,2.11)	0.945
Always	1.00		1.00
Having multiple sex partners
Yes	1.52(1.31,1.88)	0.006	1.67(1.31,2.88)	0.016
No	1.00		1.00
Diagnosis with STIs
Yes	0.49(0.06,0.59)	0.0148	1.49(0.86,2.59)	0.148
No	1.00		1.00
Relationship type
Monogamous	1.57(1.11,2.69)	0.009	1.57(0.91,2.69)	0.098
Casual	1.00		1.00

This take a look at aimed to evaluate the superiority of HIV contamination amongst discordant couples who examined HIV repute at Kibagabaga health facility over a length from 2020 to 2024. The statistics discovered a noteworthy increase in the share of HIV-positive individuals many of the couples, highlighting a critical shift within the HIV contamination dynamics inside this population. further analysis confirmed that the following factors are key predictors of HIV infection amongst discordant couples: multiple sexual partners, age of greater than forty five years, and driver profession.

have a look at findings showed that having multiple sexual partners become a ability hazard aspect for HIV infection among discordant couples. these findings are similar with different research like the examine conducted. studies which include Dunkle et al. (2008) and the partners in Prevention HSV/HIV Transmission have a look at team (2010) display that more than one partnerships make bigger the risk of HIV transmission thru multiplied publicity possibilities, which includes to drug-resistant virus traces. those findings are regular across specific regions, including sub-Saharan Africa, where a meta-evaluation by means of Mah and Halperin (2010) underscores the correlation among more than one concurrent partnerships and better HIV infection costs. moreover, psychological and social dynamics additionally play a critical function, as visible in research with the aid of Chai et al. (2014) in China, which factors to the want for culturally tailored interventions to deal with those elements effectively. Prevention techniques highlighted by Allen and Meinzen-Derr (2000) emphasize the importance of lowering the range of sexual partners and continually the usage of condoms to mitigate transmission risks among discordant couples.

Our findings found out that couples with ages extra than forty five years had been are threat of HIV infection. but, these consequences and constant with different findings. The findings that couples over the age of 45 are at risk of HIV contamination might first of all seem unexpected however are well-supported by using the literature, reflecting a broader fashion in public fitness knowledge that HIV chance is not restrained to younger individuals by myself. research inclusive of that conducted by Brooks et al. (2016) highlights that older adults have interaction in hazard behaviors similar to younger populations however are regularly neglected in preventive interventions. organic and behavioral adjustments with age, which include decreased condom use and changes in sexual characteristic, make a contribution to improved threat. furthermore, socio-

economic elements may also lead older adults to form relationships with more youthful partners, probably altering risk dynamics. research by way of Schick et al. (2014) and Zablotska et al. (2018) additionally emphasize that older adults are much less in all likelihood to be tested for HIV because of healthcare vendors' assumptions approximately their sexual pastime, that may put off diagnosis and remedy. This convergence of things underscores the want for healthcare techniques that emphasize education, testing, and prevention tailor-made to all age corporations, as echoed in comparative research like the ones with the aid of Skolnik et al. (2019), reinforcing the significance of addressing HIV danger across various populations and age brackets.

have a look at findings showed that couples wherein one of them became a driving force showed a more risk of HIV infection and this is steady with other research. The commentary that couples in which one associate is a driving force are at an expanded hazard of HIV infection is supported by severa research that check out the precise occupational dangers associated with mobile jobs. for example, drivers regularly spend long periods away from domestic, that can lead to engagement in high-danger sexual behaviors, together with interactions with commercial sex workers, as mentioned in research like those through Delany-Moretlwe et al. (2010). This transient lifestyle also can result in social isolation, further increasing the probability of seeking companionship in dangerous contexts. moreover, Lichtenstein (2015) highlights that truck drivers are specially vulnerable due to their common exposure to environments wherein casual sex is greater commonplace. Comparative studies throughout regions, which includes the examine by means of Ramjee and Gouws (2017), confirms higher prices of HIV amongst drivers, emphasizing the want for focused intervention techniques

5.1 Implications of the Study

The results of those findings are considerable for HIV control and prevention techniques. The increasing prevalence of HIV amongst discordant couples highlights the urgency of enhancing preventive measures, inclusive of enhancing get entry to to PrEP and PEP, promoting regular testing, and addressing behavioral dangers like multiple sexual partnerships. furthermore, the associations between socio-demographics and behavioral elements and HIV danger recommend the want for included care approaches that combine behavioral, and social assist to mitigate the threat of transmission and improve average health effects for discordant couples.

5.2 Strengths and Limitations

A key energy of this study is its complete analysis of a couple of factors influencing HIV threat, presenting a holistic view of the epidemic among discordant couples. using sturdy statistical methods to perceive vast institutions adds to the reliability of the findings. but, the examine also has obstacles. The observe's observational nature restricts the ability to deduce causality, and the capacity for keep in mind bias in self-stated behavioral statistics can also have encouraged a number of the findings. moreover, the look at's consciousness on a unmarried medical institution may restrict the generalizability of the consequences to different settings.

6.1 Conclusion

This study investigated the prevalence of HIV infections among couples tested at Kibagabaga Hospital between 2020 and 2024, revealing a significant increase in HIV-positive cases over time. The rise in infections among HIV-discordant couples underscores the urgent need for improved preventive measures and ongoing monitoring. The findings in this study align with existing literature that highlights the importance of regular HIV testing, adherence to antiretroviral therapy, and consistent use of preventive strategies such as condoms and pre-exposure prophylaxis (PrEP). Socio-demographic and behavioral factors, including age, education, and sexual practices, significantly influence HIV risk, with notable implications for targeted interventions.

6.2 Recommendations

V' Develop and implement targeted education and awareness programs specifically for individuals over 45 years and drivers.

V' Focus on the risks associated with multiple sexual partners and the benefits of regular HIV testing.

V' Collaborate with transportation companies and unions to introduce regular HIV prevention workshops

V' Provide free or subsidized HIV testing for drivers during routine health and safety training sessions.

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