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Background  Most incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples' voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, <1% of couples have been jointly tested.    Methods  We conducted cross-sectional household surveys in Kigali, Rwanda (n = 600) and Lusaka, Zambia (n = 603) to ascertain knowledge, perceptions, and barriers to use of CVCT.    Results  Compared to Lusaka, Kigali respondents were significantly more aware of HIV testing sites (79%  vs.  56%); had greater knowledge of HIV serodiscordance between couples (83%  vs.  43%); believed CVCT is good (96%  vs.  72%); and were willing to test jointly (91%  vs.  47%). Stigma, fear of partner reaction, and distance/cost/logistics were CVCT barriers.    Conclusions  Though most respondents had positive attitudes toward CVCT, the majority were unaware that serodiscordance between cohabiting couples is possible. Future messages should target gaps in knowledge about serodiscordance, provide logistical information about CVCT services, and aim to reduce stigma and fear.

Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey