Voluntary HIV Counseling and Testing Efficacy Study

Is HIV Counseling and Testing Effective for Prevention?

While voluntary HIV counseling and testing has been demonstrated to be useful for care and support, the effectiveness of counseling and testing for prevention has not been conclusively demonstrated [1-6]. There have been very few studies of the effectiveness of counseling and testing for prevention, and even fewer randomized trials [7-8], despite repeated calls for controlled studies[1,6,9]. While speculation continues regarding the potential usefulness of counseling and testing despite its relatively high cost, there are currently insufficient data to determine either the efficacy or the true cost of the intervention in relation to the number of infections that could be prevented by it (cost-effectiveness). Arguments in favor of more widespread HIV testing and counseling include that counseling and testing provides an opportunity for education and behavior change and that knowledge of serostatus allows individuals to plan, make important life decisions and to seek care and support [10]. On the other hand, HIV counseling and testing is an expensive intervention compared to health education and other potentially effective prevention strategies. In addition, there are potentially negative social consequences of counseling and testing including family and relationship disruption, sexual violence, stigma and discrimination [11-12]. The Voluntary HIV Counseling and Testing Efficacy Study was a clinical trial conducted in 1995-1997 to test the effectiveness and consequences of Voluntary HIV Counseling and Testing for the prevention of new HIV infections. This is an important policy issue, particularly in countries where health care resources are limited. More specifically the purpose of the study was to determine if counseling and testing, whether given to individuals or couples, might be effective in reducing risk behavior for the sexual transmission of HIV.

References

[1] Higgins DL, Galavotti C, O'Reilly K, et al. Evidence for the Effects of HIV Antibody Counseling and Testing on Risk Behaviors. JAMA 1991; 266:2419-2429. [2] DeZoysa I, Phillips KA, Kamenga MC, et al. Role of HIV counseling and testing in changing risk behavior in developing countries. AIDS 1995: S95-S101. [3] Landis SE, Earp JL, Koch GG. Impact of HIV Testing and Counseling on subsequent sexual behavior. AIDS Education and Prevention; 1992; 4:61-70. [4] Zenilman JM, Erickson B, Fox R, Reichart CA, Hook III EW. Effect of HIV posttest Counseling on STD incidence. JAMA 1992; 267:843-845. [5] Otten Jr MW, Zaidi AA, Wroten JE, Witte JJ, Peterman TA. Changes in Sexually Transmitted Disease Rates after HIV Testing and Posttest Counseling, Miami 1988 to 1989. American Journal of Public Health 1993; 83:529-533. [6] Beardsell S. Should wider HIV testing be encouraged on the grounds of HIV prevention? AIDS Care 1994; 6:5-19. [7] Wenger NS, Linn LS, Epstein M, Shapiro MF. Reduction of High-Risk Sexual Behavior among Heterosexuals Undergoing HIV Antibody Testing: A Randomized Clinical Trial. American Journal of Public Health 1991; 81:1580-1585. [8] Wenger NS, Greenberg JM, Hilborne LH, Kusseling F, Mangotich M, Shapiro MF. Effect of HIV Antibody Testing and AIDS Education on Communication about HIV Risk and Sexual Behavior. Annuals of Internal Medicine 1992; 117:905-911. [9] Phillips KA & Coates TJ. HIV counseling and testing: research and policy issues. AIDS Care 1995; 7:115-124. [10] Müller O, Barugahare L, Schwartländer B, et al. HIV prevalence, attitudes and behavior in clients of a confidential HIV testing and counseling center in Uganda. AIDS 1992; 6:869-874. [11] Colebunders R & Ndumbe P. Priorities for HIV testing in developing countries? The Lancet 1993; 342:601-602. [12] van der Straten A, King R, Grinstead O, Serufilira A, Allen S. Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS 1995; 9:935-944.