AIDS and Behavior

, Volume 11, Issue 1, pp 71–78 | Cite as

Repeat Voluntary HIV Counseling and Testing (VCT), Sexual Risk Behavior and HIV Incidence in Rakai, Uganda

  • Joseph K. B. Matovu
  • Ronald H. Gray
  • Noah Kiwanuka
  • Godfrey Kigozi
  • Fred Wabwire-Mangen
  • Fred Nalugoda
  • David Serwadda
  • Nelson K. Sewankambo
  • Maria J. Wawer
Original Paper

Abstract

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.

Keywords

Repeat VCT HIV Incidence Rakai Uganda 

Notes

Acknowledgment

The study was supported by grants RO1 A134826 and RO1 A13426S from the National Institute of Allergy and Infectious Diseases; grant 5P30HD06826 from the National Institute of Child Health and Development; the World Bank STI Project, Uganda; the Glaxo Wellcome Foundation, and the Winkler Foundation. We are grateful to Dr SK Sempala [RIP] (Former Director, Uganda Virus Research Institute) for his support. Part of this paper was presented at the Uganda Virus Research Institute, Entebbe, Uganda, on November 28, 2003.

References

  1. Ahmed S., Lutalo T., Wawer, M. J., Serwadda, D., Sewankambo, N. K., Nalugoda, F., et al. (2001). HIV incidence and sexually transmitted diseases prevalence associated with condom use: A population study in Rakai, Uganda. AIDS, 15, 2171–2179.PubMedCrossRefGoogle Scholar
  2. Allen, S., Meinzen-Derr, J., Kautzman, M., Zulu, I., Trask, S., et al. (2003). Sexual behavior of HIV discordant couples after HIV counseling & testing. AIDS, 17, 733–740.PubMedCrossRefGoogle Scholar
  3. Fernyak, S. E., Page-Schafer, K., Kellogg, T. A., McFarland, W., & Katz, M. H. (2002). Risk behaviors and HIV incidence among repeat testers at publicly funded HIV testing sites in San Francisco. Journal of Acquired Immune Deficiency Syndromes, 31, 63–70.PubMedGoogle Scholar
  4. Fisher, J. D., DelGado, B. P., Melchreit, R., & Spurlock-McLendon, J. (2002). The dynamics of repeat HIV testing, and interventions for repeat HIV testers. AIDS and Behavior, 6(2), 183–191.CrossRefGoogle Scholar
  5. Gray, R. H., Wabwire-Mangen, F., Kigozi, G., et al. (2001). Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda. American Journal of Obstetrics and Gynecology, 185, 1209–1217.PubMedCrossRefGoogle Scholar
  6. Kalichman, S. C., Schaper, P. E., Belcher, L., Abush-Kirsh, T., Cherry, C., et al. (1997). It’s like a regular part of gay life: Repeat HIV antibody testing among gay and bisexual men. AIDS Education and Prevention, 9(3 Suppl), 41–51.PubMedGoogle Scholar
  7. Kellogg, T. A., McFarland, W., Perlman, J. L., Weinstock, H., Stephanie, B., Katz, M. H., et al. (2001). HIV incidence among repeat HIV testers at a County Hospital, San Francisco, Calfornia, USA. Journal of Acquired Immune Deficiency Syndrome, 28(1), 59–64.Google Scholar
  8. Leaity, S., Sherr, L., Wells, H., Evans, A., et al. (2000). Repeat HIV testing: High-risk behavior or risk-reduction strategy? AIDS, 14, 547–552.PubMedCrossRefGoogle Scholar
  9. MacKellar, D. A., Valleroy, L. A., Secura, G. M., Bartholow, B. N., et al. (2002). Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: a call to monitor and improve the practice of prevention. Journal of Immune Deficiency Syndrome, 29(1), 76–85.Google Scholar
  10. Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndrome, 39, 446–453.CrossRefGoogle Scholar
  11. Matambo, R., Dauya, E., Mutswanga, J., Makanza, E., Chandiwana, S., et al. (2006). Voluntary counseling and testing by nurse counselors: what is the role of routine repeated testing after a negative result? Clinical Infectious Diseases, 42, 569–571.PubMedCrossRefGoogle Scholar
  12. Matovu, J. K., Gray, R. H., Makumbi, F., Wawer, M. J., et al. (2005). Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS, 19, 503–511.PubMedCrossRefGoogle Scholar
  13. Matovu, J. K., Kigozi, G., Nalugoda, F., Wabwire-Mangen, F., & Gray, R. H. (2002). The Rakai Project counseling programme experience. Tropical Medicine and International Health, 7(12), 1064–1067.PubMedCrossRefGoogle Scholar
  14. McFarland, W., Kellogg, T. A., Dilley, J., Katz, M. H. (1997). Estimation of human immunodeficiency virus (HIV) seroincidence among repeat anonymous testers in San Francisco. American Journal of Epidemiology, 146(8), 662–664.PubMedGoogle Scholar
  15. Mugerwa, R. D., Marum, L. H., Serwadda, D. (1996). Human immunodeficiency virus and AIDS in Uganda. East African Medical Journal, 73(1), 20–26.PubMedGoogle Scholar
  16. Nascimento, C. M. R., Casado, M. J., Casabona, J., Ros, R., Sierra, E., et al. (2004). Estimation of HIV incidence among repeat anonymous testers in Catalonia, Spain. AIDS Research and Human Retroviruses, 20(11), 1145–1147.PubMedCrossRefGoogle Scholar
  17. Norton, J., Elford, J., Sherr, L., Miller, R., & Johnson, M. A. (1997). Repeat HIV testers at a London same-day testing clinic. AIDS, 11(6), 773–781.PubMedGoogle Scholar
  18. Ryder, K., Haubrich, D. J., Calla, D., Myers, T., et al. (2005). Psychosocial impact of repeat HIV-negative testing: A follow-up study. AIDS and Behavior, 9, 459–464.PubMedCrossRefGoogle Scholar
  19. Serwadda, D., Mugerwa, R. D., Sewankambo, N. K., Lwegaba, A., et al. (1985). Slim disease: A new disease in Uganda and its association with HTLV III infection. Lancet, 2(8460), 849–852.PubMedCrossRefGoogle Scholar
  20. Serwadda, D., Wawer, M. J., Musgrave, S. D., et al. (1992). HIV risk factors in three geographical strata of rural Rakai district, Uganda. AIDS, 6, 983–989.PubMedCrossRefGoogle Scholar
  21. Solomon, S. S., Solomon, S., Masse, B. R., Srikrishnan, A. K., Beauchamp, G., et al. (2006). Risk reduction counseling is associated with decreased HIV transmission in high-risk Indian heterosexuals. Journal of AIDS Deficiency Syndrome, 42(4), 478–483.CrossRefGoogle Scholar
  22. Suligoi, B., Guiliani, M., Galai, N., Balducci, M., & the STD Surveillance Working Group (1999). HIV incidence among repeat HIV testers with sexually transmitted diseases in Italy. AIDS, 13, 845–850.PubMedCrossRefGoogle Scholar
  23. Voluntary HIV-1 Counseling and Testing Efficacy Study Group (2000). Efficacy of voluntary HIV-1 counseling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: A randomized trial. Lancet, 356, 103–112.CrossRefGoogle Scholar
  24. Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Li, X., Laeyendecker, O., Kiwanuka, N., et al. (2005a). Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. Journal of Infectious Diseases, 191, 1403–1409.CrossRefGoogle Scholar
  25. Wawer, M. J., Gray, R. H., Serwadda, D., Namukwaya, Z., Makumbi, F., et al. (2005b). Declines in HIV prevalence in Uganda: Not as simple as ABC. Conference on Retroviruses and Opportunistic Infections. February 22–25; 12: (abstract no. 27LB).Google Scholar
  26. Wawer, M. J., Sewankambo, N. K., Serwadda, D., et al. (1999). Control of sexually transmitted diseases for AIDS prevention in Uganda: A randomised community trial. Lancet, 353, 525–535.PubMedCrossRefGoogle Scholar
  27. Weinhardt, L. S., Carey, M. P., Johnson, B. T., & Bickham, N. L. (1999). Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. American Journal of Public Health, 89, 1397–1405.PubMedCrossRefGoogle Scholar
  28. Winer, R. L., Hughes, J. P., Feng, Q., O’Reilly, S., Kiviat, N. B., et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25), 2645–2654.PubMedCrossRefGoogle Scholar
  29. Wolitski, R. J., Macgowan, R. J., Higgins, D. L., & Jorgensen, C. M. (1997). The effects of HIV counseling and testing on risk-related practices and help seeking behavior. AIDS Education and Prevention, 9(Suppl. 3), 52–67.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Joseph K. B. Matovu
    • 1
  • Ronald H. Gray
    • 2
  • Noah Kiwanuka
    • 1
  • Godfrey Kigozi
    • 1
  • Fred Wabwire-Mangen
    • 3
  • Fred Nalugoda
    • 1
  • David Serwadda
    • 3
  • Nelson K. Sewankambo
    • 4
  • Maria J. Wawer
    • 5
  1. 1.Rakai Health Sciences Program/Uganda Virus Research InstituteEntebbeUganda
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Institute of Public Health, Makerere UniversityKampalaUganda
  4. 4.Makerere Medical SchoolMakerere UniversityKampalaUganda
  5. 5.Mailman School of Public HealthColumbia UniversityNew YorkUSA

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