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Background: While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs. Methods: Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework. Results: Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples. Conclusions: Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships. [ABSTRACT FROM AUTHOR]

Presents an editorial regarding articles found in the December 2004 issue of "Critical Public Health" on the topic of harm reduction. Statement that early harm reduction efforts in the field of HIV centered primarily on the provision of needle and syringe programs for injecting drug users; Discussion of the variation and penetration of the harm-reduction construct in public health practice; Statement that the articles address HIV, Hepatitis C, drugs and injection drugs, and alcohol and sexual risk; Reference to an article on policies and practices to address HIV/AIDS in prison settings; Article that deals with sexual health and risk management among gay and bisexual men; Limitations of purely educational interventions.

To explore syringe access patterns and implications for HIV prevention programming, data from qualitative interviews (n=120) with injection drug users (IDU) and an evaluation of a satellite syringe-exchange program (SEP) were used. Three patterns were identified: IDUs who stockpile supplies to meet their own needs and to provide secondary distribution to friends and drug-using associates; IDUs who keep a several-days supply of syringes available, primarily for their own use; and IDUs who usually obtain equipment at the time of obtaining drugs, in some cases unsterile equipment from other injectors. The first two types of injectors are typically in stable housing, while the last group are generally in unstable housing. This analysis highlights the very direct link between adequate housing and safer injection practices for HIV prevention, and points to the need to advocate more broadly on behalf of IDUs for appropriate housing, harm-reduction and social services. [ABSTRACT FROM AUTHOR]