, Volume 15, Issue 1, pp 1-8
Date: 04 Aug 2010

Serosorting and the Evaluation of HIV Testing and Counseling for HIV Prevention in Generalized Epidemics

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UNAIDS and the WHO recognize the importance of HIV Testing and Counseling (HTC) as a gateway to both treatment and prevention [1]. Many studies aimed at identifying behavioral changes following HTC have, however, registered only modest reductions in risk behaviors: change—if any—is most commonly reported by women, HIV positives, and in serodiscordant couples. This is also the gist of the review of early studies from predominantly Europe and North America [24], and a review of seven studies set in developing countries [5]. More recent studies from sub-Saharan Africa, summarized in Table 1, largely corroborate these conclusions. The most ambitious HTC impact evaluation studies target reductions in HIV incidence, but none have been detected so far [68]. In serodiscordant couples, however, HTC is associated with a reduction in HIV transmission [9].

Skeptics argue that the meager benefits of HTC for HIV prevention will dilute further as efforts are mounted to increase HTC uptak ...