Background Characterizing the epidemiology of HIV sero-discordancy among stable couples (SCs) is essential to inform HIV policy and programming, especially considering the recent availability of efficacious interventions among stable HIV sero-discordant couples (SDCs). This work complements a quantitative assessment of HIV sero-discordancy among SCs in sub-Saharan Africa (SSA), by analysing sero-discordancy in all countries outside SSA for which HIV biomarker demographic and health surveys (DHS) are available.

Methods We derived measures of HIV sero-discordancy using nationally-representative DHS data for Cambodia, the Dominican Republic (DR) including a sub-population at higher risk of HIV (Bateyes-DR), Haiti, and India. Vietnam was excluded from our analysis because of the low number of couples affected by HIV (3 couples).

Results HIV was more prevalent in Bateyes-DR (3.3%) and Haiti (2.2%) than in other settings (< 1%). About two-third of the population in reproductive age in these countries were engaged in SCs. The proportions of SCs affected by HIV and of SDCs were, respectively, 5.7% and 4.2% (Bateyes-DR), 4.7% and 3.2% (Haiti), 1.2% and 0.9% (DR), 1.0% and 0.5% (Cambodia), and 0.5% and 0.4% (India). Among SCs affected by HIV, 74.3% were sero-discordant in Bateyes-DR compared to 68.3% in Haiti, 70.1% in DR, 51.6% in Cambodia, and 78.5% in India. About a third of HIV sero-positive persons had uninfected partners: 38.3% (Bateyes-DR), 35.4% (Haiti), 33.3% (DR), 32.1% (Cambodia), and 39.6% (India). Limited sero-discordancy was observed at the population-level with at most two out of every 100 adults in reproductive age being engaged in a SDC.

Conclusions Our findings are consistent with HIV sero-discordancy patterns in low prevalence settings in SSA. While the large sero-discordancy among SCs affected by HIV offers an opportunity for HIV prevention, the small number of SCs affected by HIV at the population-level suggests logistical difficulties for implementing SDC-targeted prevention interventions in these countries.