Serosorting and the Evaluation of HIV Testing and Counseling for HIV Prevention in Generalized Epidemics
- 170 Downloads
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 [ 2, 3, 4], 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 [ 6, 7, 8]. In serodiscordant couples, however, HTC is associated with a reduction in HIV transmission [ 9].
Description of selected HTC efficacy studies in sub-Saharan Africa and their main findings
KeywordsSexual Partnership Serodiscordant Couple Partner Characteristic Generalize Epidemic Seroadaptive Behavior
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
We thank Susan Watkins and the journal’s reviewers for their comments and suggestions.
- 1.UNAIDS/WHO. UNAIDS/WHO Policy Statement on HIV Testing. 2004. http://www.who.int/rpc/research_ethics/hivtestingpolicy_en_pdf.pdf. Accessed 24 June 2009.
- 29.Truong HM, Kellogg T, Klausner JD, Katz MH, Dilley J, Knapper K, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting? Sex Transm Infect. 2006;82(6):461–6.CrossRefPubMedGoogle Scholar
- 31.BBC. Love aid for Ethiopians with AIDS. 2003. http://news.bbc.co.uk/2/hi/africa/2989142.stm. Accessed 24 June 2009.
- 32.BBC. India HIV couples to tie the knot. 2006. http://news.bbc.co.uk/2/hi/health/5399706.stm. Accessed 24 June 2009.
- 33.IRIN. Kenya: where only HIV-positive people get beyond the velvet rope. 2008. http://www.plusnews.org/Report.aspx?ReportId=81714. Accessed 24 June 2009.
- 34.BBC. HIV-positive Zimbabweans find love. 2006. http://news.bbc.co.uk/2/hi/africa/5216864.stm. Accessed 26 Jul 2009.
- 35.Economist. Positive dating: HIV sufferers find love online. 12 Oct 2006.Google Scholar
- 41.IRIN. Nigeria: “With this HIV test, I thee wed”. 2008. http://www.plusnews.org/report.aspx?ReportId=81573. Accessed 22 Dec 2009.
- 46.MoHSS, Macro International Inc. Demographic and Health Survey 2006–07. Windhoek, Namibia and Calverton, MD, USA: Ministry of Health and Social Services and Macro International Inc.; 2008.Google Scholar
- 47.CSO [Swaziland], Macro International Inc. Swaziland Demographic and Health Survey 2006–07. Mbabane, Swaziland: Central Statistical Office and Macro International Inc.; 2008.Google Scholar
- 48.CSO [Zambia], MOH, TDRC, University of Zambia, Macro International Inc. Zambia Demographic and Health Survey 2007. Calverton, MD, USA: Central Statistical Office and Macro International Inc.; 2009.Google Scholar
- 51.The Voluntary HIV-1 Counselling and Testing Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Lancet. 2000;356(9224):103–12.Google Scholar
- 53.Helleringer S, Reniers G. Study designs fail to represent the intricate effects of HIV testing and counselling on condom use and HIV transmission in sub-Saharan Africa. Int J Epidemiol. 2010. doi: 10.1093/ije/dyq075.
- 55.Khumalo-Sakutukwa G, Morin SF, Fritz K, Charlebois ED, van Rooyen H, Chingono A, et al. Project Accept (HPTN 043): a community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand. J Acquir Immune Defic Syndr. 2008;49(4):422–31.CrossRefPubMedGoogle Scholar
- 62.Huchko MJ, Montandon M, Nguti R, Bukusi EA, Cohen CR. The association of HIV counseling and testing with HIV risk behaviors in a random population-based survey in Kisumu, Kenya. AIDS Behav. 2009. doi: 10.1007/s10461-009-9649-4.
© Springer Science+Business Media, LLC 2010