Repeat Voluntary HIV counseling and testing (VCT), sexual risk behavior and HIV incidence in Rakai, Uganda

Rakai Health Sciences Program/Uganda Virus Research Institute, Entebbe, Uganda.
AIDS and Behavior (Impact Factor: 3.49). 02/2007; 11(1):71-8. DOI: 10.1007/s10461-006-9170-y
Source: PubMed


We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.

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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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    • "Among MSM, repeat testers are often younger, better educated and unmarried compared to first-time testers [7–9]. However, repeat testing is associated with several risk factors for HIV: a higher number of sexual partners [10], having ever had an STI [11], unprotected anal intercourse (UAI) [12, 13] and working as a male sex worker [14]. Additionally, in a study among MSM in seven US cities, over 75% of repeat testers who seroconverted did so within a year after their last test [13]. "
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    ABSTRACT: Introduction Little is known about HIV testing, HIV infection and sexual behaviour among bathhouse patrons in China. This study aims to assess differences in HIV prevalence and high-risk sexual behaviours between repeat and first-time testers among men who have sex with men (MSM) attending bathhouse in Tianjin, China. Methods Between March 2011 and September 2012, a HIV voluntary counselling and testing station was established in a gay bathhouse, which provided HIV testing and conducted a survey among participants recruited through snowball sampling. Differences in demographic and high-risk sexual behaviours between repeat and first-time testers were assessed using the chi-square test. Univariate and multivariate logistic regression analyses were conducted to identify predictors for HIV infection. Results Of the 1642 respondents, 699 (42.6%) were repeat testers and 943 (57.4%) were first-time testers. Among repeat testers, a higher proportion were men aged 18 to 25, single, better educated, had a history of STIs and worked as male sex workers or “money boys” (MBs). Repeat testers were less likely to report having unprotected anal intercourse in the past six months. The overall HIV prevalence was 12.4% (203/1642). There was no difference in HIV prevalence between repeat (11.2%, 78/699) and first-time (13.3%, 125/943) testers. The HIV prevalence increased with age among first-time testers (χtrend2=9.816, p=0.002). First-time MB testers had the highest HIV prevalence of 34.5%. Conclusions MSM attending bathhouse had an alarmingly high HIV infection rate, particularly in MB. Targeted interventions are urgently needed especially focusing on older MSM and MBs.
    Full-text · Article · Jul 2014 · Journal of the International AIDS Society
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    • "Our study examining the trends in HCT among 21,798 married individuals enrolled in the Rakai Community Cohort Study (RCCS) between 2003-2009 reveals three interesting and important trends: (i) the proportion of never-tested individuals increased significantly over time, (ii) uptake of individual HCT increased between 2003 and 2005 but declined between 2006 and 2009, and (iii) uptake of couples’ HCT remain low and stabilized below 30%. We also found among a sub-set of our study population that prior receipt of HCT was a significant predictor of individual and couples’ HCT, suggesting high levels of repeat testing [27] and the need to devise alternative approaches to create demand for HCT uptake among individuals with no prior HCT. "
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    ABSTRACT: Despite efforts to promote HIV counseling and testing (HCT) - among couples, few couples know their own or their partners' HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples' HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used chi2 tests to assess linear trends in individual and couples' HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95%CI) associated with individual and couples' HCT uptake. Analysis was done using STATA version 11.0. Uptake of couples' HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (chi2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (chi2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (chi2 for trend = 18.16; P < 0.0001). Uptake of couples' HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95%CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95%CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95%CI: 1.26, 4.80). Uptake of couples' HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples' HCT, particularly among younger couples and those with no prior HCT.
    Full-text · Article · Jul 2013 · BMC Public Health
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