Background:  HIV transmission in Sub-Saharan Africa often occurs within HIV discordant couples. Although females are known to have higher HIV prevalence than  males in the general population in Uganda, little is known about HIV prevalence by gender in discordant relationships. 

Methods:  We evaluated program data from the full-access, district-wide door-to-door Home-Based HIV Counseling and Testing (HBCT) program conducted in Bushenyi District of Uganda during January 2005 to October 2006.  HIV testing was performed for all clients aged 15 years and older after obtaining informed consent/assent.

Results:  Of 281,239 eligible clients, 223,290 (79%) were present, and of these, 222,690 (99%) accepted HIV testing in their home. Among these, 10,188 (4.6%) tested HIV⁺. Males and females had a HIV prevalence of 3.5% and 5.5% respectively (p <0.0001). HBCT was accepted by 29,454 couples. Of these, 1369 (4.6%) had 1 or more HIV⁺ couple members and 866 couples (2.9% of all couples, 63.3% of all HIV-infected couples) were HIV discordant. Among the 1730 individuals identified in discordant partnerships, 830 were males and of these 452 (54.5%) were HIV⁺; 900 were females and of these, 288 (32.0%) were HIV⁺. Due to polygamy, men could be both in HIV concordant and discordant partnerships. The median age among discordant couple members was 39 years (interquartile-range IQR 32 to 48) in males and 30 years (IQR 25 to 39) in females. Among the 829 individuals in discordant  partnerships who reported having sexual intercourse  in the previous 3 months, 744 (89.7%) never used  condoms.

Conclusions:  In Bushenyi District, among couples tested for HIV, discordance is frequent, whereas condom use in discordant partnerships is not. Although HIV prevalence is lower in males than females, males in discordant partnerships are more often HIV infected than females. In high prevalence settings, couples should know their HIV status. More preventive strategies in addition to condom use need to be promoted to protect the uninfected in these high-risk partnerships and specific prevention technologies to protect females are urgently needed.