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 relationship 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 . 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.  Müller O, Barugahare L, Schwartländer B, et al. HIV prevalence, attitudes and behaviour in clients of a confidential HIV testing and counselling centre in Uganda. AIDS 1992; 6:869-874.  Colebunders R & Ndumbe P. Priorities for HIV testing in developing countries? The Lancet 1993; 342:601-602.  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.