This study was carried out on sites involved in the Prevention of Mother-to-Child Transmission (PMTCT) and care and support for People Living with HIV (PLHIV) in the town of Parakou, in northeastern Benin. Parakou is the country’s 4^th largest city, located 415 km from the capital, Cotonou. In 2019, there were 255,478 people including 127,328 men, giving a sex ratio of 0.99. The most widely spoken local language is Bariba (Baatombu) [8] . In 2015, the monetary poverty index was 24.85. The non-income poverty index was 29.7 [incidence]. Since 2001, the township has been a university town and as a result, research activities are plentiful. In terms of HIV response, Parakou has 23 PMTCT sites and 7 care and support sites.

This was a descriptive cross-sectional study with an analytical focus, conducted over a 6-month period from July to December 2022. Data were collected during a face-to-face interview in which a semi-structured questionnaire was shared. Individuals matching the following criteria were selected to participate in the present study: individuals aged 18 and over, all genders, HIV-positive, engaged in a serodiscordant relationship for at least 6 months, received during the study period and have consented to participate in the study. We used non-probability sampling for convenience. Then, subjects received during the study period at the collection sites for their follow-up appointments or antiretroviral (ARV) supply and matching the selection criteria were also offered participation in the study. Based on the prevalence of shared serostatus expressed in a similar population in Burkina Faso [9] , the minimum sample size calculated using the Schwartz formula was 288 targets. Patient privacy and data confidentiality were ensured. Subjects who gave their free consent to take part in the study were surveyed, with the assurance that they could withdraw at any time. To ensure greater openness on subjects that are sometimes sensitive or even taboo, the data collectors were health staff assigned to dispensing ARVs and keeping medical records. They were trained and assisted during the first days of data collection to ensure the quality of the data collected. The questionnaire, validated by the research unit, was structured in two parts: the first part focused on the life and experiences of the respondents and covered the socio-demographic aspects of the participants, their background, their behaviours in relation to managing the risk of HIV transmission, and their day-to-day experience of serodiscordance at the marital and psycho-social levels. The second part of the questionnaire collected clinical and therapeutic data from the patients’ files.

A couple is defined here as two people of the opposite sex, linked by common interests, commitments and projects, who have decided to live together regardless of their residential status and form of union. Sharing of serostatus within a couple was defined as self-reported sharing of HIV status information with a current or recent partner whose serostatus is known and negative.

Data processing and analysis were performed using R 4.3.1 software. Quantitative variables were expressed by their mean and standard deviation. Categorical or quantitative variables were presented by their proportion. A significance level of 5% was used to confirm the statistical link between the two variables. The Pearson Chi-square test (numbers > 5) or the Fisher test (numbers ≤ 5) were used to compare qualitative variables. Logistic regression was used to determine which of the statistically associated variables were potential predictors of shared serostatus among serodiscordant couples in the city of Parakou in 2022.

Several variables showed a statistically significant association at the α = 5% threshold with HIV serostatus sharing.

Of the eight variables statistically associated with shared serostatus in univariate analysis, five potential predictors were retained by the multivariate analysis model. These were: marital status, household type, spouse’s level of education, type of site and involvement of extended family (Table 9).

Married PLHIV were 4 times more likely to share their serostatus with their spouse than unmarried participants (p < 0.001). Being involved in a polygamous household halved the chances of a PLHIV in the city of Parakouto sharing their serostatus with their spouse (p = 0.016). The higher the spouse’s level of education, the greater the chances that the respondent would share his status with him. Thus, when the spouse had a higher level of education, the chances of his HIV-positive partner sharing his status with him were multiplied by 3 (p = 0.008). PLHIV treated at PMTCT sites were 3 times more likely to share their HIV status with their partner than those treated at ECP sites (p = 0.001). The support and involvement of extended families in day-to-day conflict management increased the chances of serostatus sharing among serodiscordant couples by a factor of 2.7 (p = 0.001).

According to the results obtained in our study, the prevalence of serostatus sharing among serodiscordant couples in the city of Parakou in 2022 was 47.83%. While the intention to share one’s serostatus is high, as shown by Alassani et al. [7] in Parakou in 2020 with a proportion of 92.41%, actual sharing in the event of the announcement of a positive result remains low. Coutherut and Desclaux [7] in Senegal reported a serostatus sharing rate of 66%, but only 27% of cases were shared with the spouse. For Kouanda et al. [3] in Burkina Faso, while 81.4% of PLHIV surveyed had shared their serostatus with at least one person, the spouse was the recipient of this information in only 28.8% of cases.

Our result is lower than that reported by Millogo [9] in Burkina Faso, where 75% of participants had informed their HIV-negative spouse. Other authors have found higher proportions of status sharing than we have, but these studies were carried out within couples without distinction as to the status of the spouses. Yaya [10] in Sokodé, Togo; Diemer [11] in Bangui and Yaméogo [12] in Burkina-Faso reported prevalences of 60.9%, 70.3% and 59.1% respectively. For Rispel et al. [13] , in Tanzania and South Africa, 81% of seropositive participants had disclosed their serodiscordant status to a third party. However, very few lived openly as a serodiscordant couple. The wide gap between the intention to share one’s HIV status and the actual act of doing so undoubtedly echoes the major difficulties faced by PLHIV in our society. There are multiple barriers, mainly social in nature [2] , which prevent infected people from sharing their status. This leads to fears of increased risk-taking within couples, with a heightened risk of transmission, both sexual and vertical. For the adoption of preventive changes aimed at averting any further risk of sexual transmission of HIV requires informing the partner and, subsequently, getting him or her to adhere to these strategies. In our study, while all participants were on ART (100.0%), 14% showed poor adherence and 16% had a high viral load. This implies the adoption of additional preventive strategies, which cannot be discussed with the spouse unless he or she is informed of his or her partner’s HIV status. Thus, according to our results, nearly three out of five respondents (58.85%) did not use a condom with their partner. Strategies to prevent transmission of the virus within these couples are therefore not optimal, contrary to the recommendations made by health workers and care protocols.

For the 156 participants (52.17%) who had not shared their serostatus with their spouse, the reasons most often cited were: the risk of being expelled from the marital home, fear of stigmatization/discrimination among participants and the risk of disclosure of serostatus.

Alassani et al. [7] , in a study about pregnant women in Parakou, found that the main reasons women gave for sharing their status with their partner were to seek their partner’s support (42.6%) and to have their partner as a confidant (29.2%). According to the same authors, 87.5% of women who had not shared their serostatus with their spouse have mentioned fear of repudiation. In Burkina Faso, sharing of status information was considered a risk to stability and peace in the home [9] . Sow reports that women fear the destabilization of their household, as well as the conflicts and suspicions that might ensue. Thus, not informing their partner would be a way of protecting themselves [14] . Kra highlighted the following as the main reasons for not sharing in Bouaké: fear of disclosure (15.7%), lack of trust (15.7%), fear of rejection or abandonment (15.4%), stigmatization (14.4%) and discrimination (12.5%) by family and friends [15] .

Fear of rejection and fear of losing one’s social status thus appear to be the main barriers to sharing the serostatus of surveyed PLHIV with their spouses, beyond the risk of transmission.

In our study, 54.24% of men had shared their serostatus, compared with 46.25% of women. This finding was made by Obermeyer [16] in Burkina-Faso, where women shared their serostatus less frequently than men. In fact, only 33% of women versus 67% of men had disclosed their HIV status to their partner. For Kouanda et al. on the other hand, men shared their HIV status with their partners more frequently than women, but this difference was not statistically significant (p = 0.6). Yaméogo reported that men shared more information with their partners than women (p < 0.001) [12] .

This may be explained by the status of women in African societies, which makes them more vulnerable to the possible negative consequences that could result from the announcement of their serostatus, especially in the specific case of serodiscordance. For Coutherut and Desclaux, gender inequalities underlie the low rates of sharing by women: women in situations of dependence on their spouse announce their status less than others [7] . Women are less likely to share their serostatus with their partners, for fear that their infection will be attributed to “infidelity” or “an immoral sexual history” [9] .