The prevalence and determinants of female serodiscordance among HIV positive pregnant women attending PMTCT clinic in Owerri, Imo state, Nigeria

Innocent O. Eze, Chijioke Okeudo, Bamidele U. Ezem, Clara U. Ukoh, Emily A. Nzeribe, Uchenna Nwagha, Tobechi Njoku, Onyeka Uzoma, Onyebuchi A. Duke


Background: Human Immunodeficiency Virus sero-discordance is high among heterosexual couples in Africa. However, only few studies have explored the factors that are associated with the prevalence in sub-Saharan Africa. The aim of this study was to determine the prevalence of female sero-discordance among HIV positive pregnant women in Owerri and to assess its possible associated factors.

Methods: A cross sectional study of pregnant women (and their partners) who tested positive to HIV I and II at the Prevention of Mother to Child Transmission (PMTCT) clinic from December 2015 to May 2016 in Federal Medical Center Owerri, Imo state, Nigeria.

Results: A total of 106 HIV positive pregnant women (and their partners) were studied. The prevalence of female serodiscordance was 63.2% (67/106). Pre-marital serodiscordance contributed about 52.2% (35/67) female serodiscordance among couples in the study. Sero-discordance rate for the lower, middle, and upper classes were 50% (28/56), 76.1% (35/46) and 100% (4/4) respectively and was statistically significant (p<0.01). Condom use was significantly associated with female serodiscondance (P<0.01). CD4+ count of the female partner at booking was also found statistically significantly associated with female serodiscordance (P<0.01).

Conclusions: There is high prevalence of female serodiscordance among HIV positive pregnant women in Owerri. Pre-marital serodiscordance contributed significantly to high level of female serodiscordance among couples. Higher social class, condom use and high female- partner CD4+ count are significantly associated with female sero-discordance.


HIV, Pregnant women, Sero-discordant

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Federal Ministry of Health. Fact Sheet: National HIV Sero-prevalence Sentinel Survey among Pregnant Women Attending Antenatal Clinics in Nigeria, 2015. Available at:

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. Lancet. 2008;371(9631):2183-91.

Hugonnet S, Mosha F, Todd J, Mugeye K, Klokke A, Ndeki L, et al. Incidence of HIV infection in stable sexual partnerships: a retrospective cohort study of 1802 couples in Mwanza Region, Tanzania. J Acquire Immune Defic Syndr. 2002;30:73-80.

Hudson CP. The importance of transmission of HIV-1 in discordant couples in the population dynamics of HIV-1 infection in rural Africa. Int J STD AIDS. 1996;7:302-6.

Sagay AS, Onakewhor J, Galadanci H, Emuveyan EE. HIV status of partners of HIV positive pregnant women in different regions of Nigeria: matters arising. Afr J Med Med Sci. 2006;35Suppl:125-9.

Ezeama CO, Eleje GU, Okonkwo T, Ikechebelu JI. Partner human immunodeficiency virus sero-discordance in Nnewi, Nigeria. J HIV Hum Reprod. 2014;2:2-7.

Onovo A. Prevalence of sero-discordance among pregnant women attending PMTCT services and their partners in Cross-River State, Ngeria.:6th IAS Conference on HIV Pathogenesis and Treatment: Abstract no. CDC338.

Chemaitelly H, Cremin I, Shelton J, Hallett TB, Abu-Raddad LJ. Distinct HIV discordancy patterns by epidemic size in stable sexual partnerships in sub-Saharan Africa. Sex Transm Infect. 2012;88(1):51-7.

Carpenter LM, Kamali A, Ruberantwari A, Malamba SS, Whitworth JA. Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero-status of the partners. AIDS. 1999;13(9):1083-9.

Lurie MN, Williams BG, Zuma K, Mkaya-Mwamburi D, Garnett GP, Sweat MD, et al. Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. AIDS. 2003;17(15):2245-52.

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. Lancet Infect Dis. 2010;10 (11):770-7.

Guthrie BL, de Bruyn G, Farquhar C. HIV-1-discordant couples in sub-Saharan Africa: explanations and implications for high rates of discordancy. Curr HIV Res. 2007;5(4):416-29.

Damien de Walque (Development Research Group, The World Bank). Discordant couple; HIV infection among couples in Burkina Faso, Ghana, Cameroon, Kenya and Tanzania. 2006.

Ujah I, Ezechi O, Aigbe G. HIV status discordance: associated factors among HIV positive pregnant women in Lagos, Southwest Nigeria. Afr J Reprod Health. 2015;19(2):108-16.

Gray RH, Wawer MJ, Brookmeyer R, Sewankambo NK, Serwadda D, Wabwire-Mangen F, et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet. 2001;357(9263):1149-53.

Olusanya O, Okpere E, Ezimokhai M. The importance of social class in fertility control in a developing country. West African J Med. 1985;4:205-12.

Serwadda D, Gray RH, Wawer MJ, Stallings RY, Sewankambo NK, Konde-Lule Bongs Lainjo JK, et al. The social dynamics of HIV transmission as reflected through discordant couple in Uganda. AIDS. 1995;9(7):745-50.

Allen S, Tice J, Van de Perre P, Serufilira A, Hudes E, Nsengumuremyi F, et al. Effect of sero-testing with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ. 1992;304(6842):1605-9.

Ezeanochie M, Olagbuji B, Ande A, Oboro V. Fertility preferences, condom use, and concerns among HIV-positive women in sero-discordant relationships in the era of antiretroviral therapy. Int J Gynaecol Obstet. 2009;107(2):97-8.