Introduction: Support from family and spouse is beneficial for a HIV infected individual to adhere to better practices. Even though many studies have studied role of literacy of PLHIV for positive prevention, there is a paucity of information in India, about the role of Spouse?s education in better practices related to HIV care Aims: To study the role of educational status of both index PLHIV and spouse on positive prevention practices Methods: A multi centric cross-sectional study was conducted among serodiscordant couples, in Karnataka. Using a simple random technique, 277 serodiscordant PLHIV?s participated in the study. Results: Higher proportions of PLHIV who were illiterate reported not using condoms with spouse while compared to those with higher education (p<0.05). Poorly literate also reported of experiencing a higher level of STIs (p<0.01) and Opportunistic Infections (p<0.05). Level of education of spouse found to be significantly associated with ART adherence (p<0.01). Conclusions: Literacy level of both index PLHIV and spouse has an important role in practicing of positive prevention measures. PLHIVs who are in serodiscordant relationships, who have lower education and those who have a spouse with lower education should be focused in our care and support services to achieve better positive prevention practices and higher adherence levels in ART