Sexual Behavior and Perceived HIV Risk Among HIV-Negative Members of Serodiscordant Couples in East Africa


HIV risk perception may influence the use of HIV prevention interventions. Using data from HIV-negative adults enrolled in a study of pre-exposure prophylaxis (PrEP) and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda, we examined associations between: (1) condom use and risk perception and (2) risk perception and PrEP adherence. Two-thirds of HIV-negative partners reported condomless sex with their HIV-positive partner or another partner in the month prior to study enrollment. Compared to those who reported no condomless sex, participants who reported condomless sex during the month prior to study visit had fivefold higher odds of reporting “high risk” vs “no risk” perception (36.3 versus 10.9%: aOR 4.9, 95% CI 3.4–6.9). Reporting condomless sex in the most recent sex act was associated with increased odds of perceiving some HIV risk (aOR for high risk = 7.3, 95% CI 4.9–10.8; aOR for moderate risk = 4.8, 95% CI 3.5–6.7; aOR for low risk = 3.5, 95% CI 2.7–4.6). We found no significant association between risk perception and PrEP adherence. Sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual’s decisions about PrEP use.

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Data Availability

Data are available upon request to the authors’ research center by emailing


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We thank the couples who participated in this study for their motivation and dedication, and the referral partners, community advisory groups, institutions, and communities that supported this work. Partners Demonstration Project Team: Coordinating Center (University of Washington) and collaborating investigators (Harvard Medical School, Johns Hopkins University, Massachusetts General Hospital): Jared Baeten (protocol chair) (University of Washington, Seattle, USA), Connie Celum (protocol co-chair) (University of Washington, Seattle, USA), Renee Heffron (project director) (University of Washington, Seattle, USA), Deborah Donnell (statistician), Ruanne Barnabas, Jessica Haberer (Massachusetts General Hospital, Boston, USA), Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware, Monique Wyatt. Project sites: Kabwohe, Uganda (Kabwohe Clinical Research Centre): Stephen Asiimwe, Edna Tindimwebwa. Kampala, Uganda (Makerere University): Elly Katabira, Nulu Bulya. Kisumu, Kenya (Kenya Medical Research Institute): Elizabeth Bukusi, Josephine Odoyo. Thika, Kenya (Kenya Medical Research Institute, University of Washington): Nelly Rwamba Mugo, Kenneth Ngure. Data management: DF/Net Research


The Partners Demonstration Project was funded by the Bill & Melinda Gates Foundation (OPP1056051), the National Institute of Mental Health of the US National Institutes of Health (R01MH095507) and the United States Agency for International Development (AID-OAA-A-12-00023). This work is made possible by the generous support of the American people through USAID; the contents are the responsibility of the authors and do not necessarily reflect the views of USAID, NIH, or the United States Government.

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Correspondence to Renee Heffron.

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Conflict of interest

Gilead Sciences donated the PrEP medication but had no role in data collection or analysis. The authors disclosed no competing interests.

Ethical Approval

The study protocol was approved by the Human Subjects Division at the University of Washington (#STUDY00001674) and Ethics Review Committees overseeing each study site: Scientific Ethics Review Unit at the Kenya Medical Research Institute (SSC No. 2441), the Ethics Review Committee of Kenyatta National Hospital (P286/05/2012), and the AIDS Research Committee of the Uganda National Council of Science and Technology (ARC 135 and ARC126).

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Wanga, V., Baeten, J.M., Bukusi, E.A. et al. Sexual Behavior and Perceived HIV Risk Among HIV-Negative Members of Serodiscordant Couples in East Africa. AIDS Behav 24, 2082–2090 (2020).

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  • HIV
  • Risk perception
  • Serodiscordant
  • Condomless sex
  • PrEP