Sherr L, Lopman B, Kakowa M, et al. Voluntary counselling and testing: Uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort

Department of Infectious Disease Epidemiology, Imperial College London, Londinium, England, United Kingdom
AIDS (Impact Factor: 5.55). 05/2007; 21(7):851-60. DOI: 10.1097/QAD.0b013e32805e8711
Source: PubMed


To examine the determinants of uptake of voluntary counselling and testing (VCT) services, to assess changes in sexual risk behaviour following VCT, and to compare HIV incidence amongst testers and non-testers.
Prospective population-based cohort study of adult men and women in the Manicaland province of eastern Zimbabwe. Demographic, socioeconomic, sexual behaviour and VCT utilization data were collected at baseline (1998-2000) and follow-up (3 years later). HIV status was determined by HIV-1 antibody detection. In addition to services provided by the government and non-governmental organizations, a mobile VCT clinic was available at study sites.
Lifetime uptake of VCT increased from under 6% to 11% at follow-up. Age, increasing education and knowledge of HIV were associated with VCT uptake. Women who took a test were more likely to be HIV positive and to have greater HIV knowledge and fewer total lifetime partners. After controlling for demographic characteristics, sexual behaviour was not independently associated with VCT uptake. Women who tested positive reported increased consistent condom use in their regular partnerships. However, individuals who tested negative were more likely to adopt more risky behaviours in terms of numbers of partnerships in the last month, the last year and in concurrent partnerships. HIV incidence during follow-up did not differ between testers and non-testers.
Motivation for VCT uptake was driven by knowledge and education rather than sexual risk. Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT. It should be minimized with appropriate pre- and post-test counselling.

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    • "Other than biases that may arise from misreporting of information on sexual behaviours, cross-sectional studies prohibit the distinction between cause and effect[39]and as such it is difficult to establish whether the reported sexual risk behaviours preceded HIV testing or vice-versa. In one local prospective study, women who tested HIV-positive reported increased condom use in their regular relationships whilst those who tested HIV-negative were more likely to adopt risky behaviours in terms of numbers of previous or concurrent partnerships[40]. In another meta-analysis of 11 independent studies in the United States,[41]the prevalence of high-risk sexual behaviours was reduced substantially after people became aware that they were HIV-infected. "
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    ABSTRACT: Introduction: Zimbabwe has a high human immunodeficiency virus (HIV) burden. It is therefore important to scale up HIV-testing and counseling (HTC) as a gateway to HIV prevention, treatment and care. Objective: To determine factors associated with being HIV-tested among adult men and women in Zimbabwe. Methods: Secondary analysis was done using data from 7,313 women and 6,584 men who completed interviewer-administered questionnaires and provided blood specimens for HIV testing during the Zimbabwe Demographic and Health Survey (ZDHS) 2010-11. Factors associated with ever being HIV-tested were determined using multivariate logistic regression. Results: HIV-testing was higher among women compared to men (61% versus 39%). HIV-infected respondents were more likely to be tested compared to those who were HIV-negative for both men [adjusted odds ratio (AOR) = 1.53; 95% confidence interval (CI) (1.27-1.84)] and women [AOR = 1.42; 95% CI (1.20-1.69)]. However, only 55% and 74% of these HIV-infected men and women respectively had ever been tested. Among women, visiting antenatal care (ANC) [AOR = 5.48, 95% CI (4.08-7.36)] was the most significant predictor of being tested whilst a novel finding for men was higher odds of testing among those reporting a sexually transmitted infection (STI) in the past 12 months [AOR = 1.86, 95%CI (1.26-2.74)]. Among men, the odds of ever being tested increased with age ≥20 years, particularly those 45-49 years [AOR = 4.21; 95% CI (2.74-6.48)] whilst for women testing was highest among those aged 25-29 years [AOR = 2.01; 95% CI (1.63-2.48)]. Other significant factors for both sexes were increasing education level, higher wealth status and currently/formerly being in union. Conclusions: There remains a high proportion of undiagnosed HIV-infected persons and hence there is a need for innovative strategies aimed at increasing HIV-testing, particularly for men and in lower-income and lower-educated populations. Promotion of STI services can be an important gateway for testing more men whilst ANC still remains an important option for HIV-testing among pregnant women.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "Risk compensation will likely be the bane of vaccines against the virus (Blower and McLean, 1994). While voluntary counselling and testing promotes more condom use among those tested positive for HIV, the majority who test negative have been observed to either maintain risky sexual practices or adopt riskier sexual practices (Corbett et al., 2007; Matovu et al., 2007; Sherr et al., 2007; Weinhardt et al., 1999). Circumcised men have also been observed to have riskier sexual practices than uncircumcised men, likely in response to the awareness of decreased susceptibility to HIV (Bailey et al., 1999). "
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    ABSTRACT: Background: The failure to stem HIV in sub-Saharan Africa and the unique epidemiological modes of infection within this region have demonstrated that unique strategies for combatting the virus are required. This review article discusses why international AIDS campaigns in sub- Saharan Africa have largely been unsuccessful, and what, if any, strategies have worked.Methods: Articles were compiled using Web of Science and Google Scholar search ngines.Results: Inspired by past successes in the West and in Southeast Asia, Western AIDS initiatives have attempted to replicate these results within the African continent through ‘risk reduction’ approaches, vying to reduce the probability of HIV transmission per coital act via physical or biochemical barriers such as condoms, male circumcision, antiretroviral therapy, post-exposure prophylactic drugs, and treatment of sexually transmitted infections. However, more than three decades of research have demonstrated that the most successful strategies were African-inspired, relied on local resources with minimal Western support, culturally relevant, and used social engineering programs that dismantled networks of sexual relationships by promoting the practice of abstinence, reducing the number of sexual partners, discouraging multiple and concurrent relationships, delaying sexual debut, and maintaining mutually monogamous relationships.Conclusion: Known through the mnemonic ‘ABC’ (Abstinence, Be faithful, Condoms), this strategy was first implemented in Uganda, yielding remarkable successes both in Uganda and thereafter in other African nations in stemming HIV. AIDS agencies should support and encourage programs that use this culturally sensitive, low cost, and effective strategy.
    Preview · Article · Dec 2015 · African Journal of Infectious Diseases
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    • "These service-delivery models include the provider-initiated-counselling and testing (PICT), HCT at special events or campaigns, HCT at workplaces and at special places such as prisons. The quality of HIV counselling and testing is critical in ensuring the potential impact of risk reduction (Sherr et al. 2007). The current predominant counselling models such as the Egan model in South Africa and the TASO model in Uganda are seen as less structured to effect any behavioural change compared to the risk reduction model used in many other parts of the world (Van Rooyen et al. 2010). "
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    ABSTRACT: HIV counselling and testing (HCT) has become increasingly available in South Africa since the 1990s. Over 4500 public health facilities offer client and provider-initiated HIV counselling and testing. Counselling and testing remain key components of HIV/AIDS prevention as they provide an entry point into prevention, care, treatment and support services. This paper examines the quality of HIV counselling in government and Non-governmental (NGO) facilities and reviews adherence to the HCT policy guidelines during counselling sessions in 67 HIV counselling and testing (HCT) sites across 8 South African provinces.The assessment used both quantitative and qualitative methods. In total 149 structured observations of counselling sessions were conducted using a written checklist and audio recording. This assessment confirms that while counselling does occur prior and post HIV testing, the quality of counselling differs between sites and does not match the South African HCT policy guidelines. The following key aspects were not adequately discussed with clients: risk assessment and reduction, partner involvement, supportive care and treatment for those testing HIV positive. Confidentiality was also compromised by frequent interruptions during some sessions. The assessment indicated that ongoing training and mentoring of counsellors needs to be addressed, to make the HCT programme more effective.
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