News Release

Voluntary HIV Counseling And Testing Reduce Risk Behavior In Developing Countries

Peer-Reviewed Publication

University of California - San Francisco

Geneva, Switzerland -- HIV counseling and testing programs are very effective and relatively inexpensive ways for developing countries to curb sexual risk behaviors that can lead to HIV infection, according to new research findings. "We designed a study to definitively answer whether it is cost effective to invest in these services in the developing world, and the simple answer is 'yes' ", said Thomas J. Coates, PhD, director of the University of California San Francisco AIDS Research Institute (UCSF ARI).

He added, however, that most individuals in developing nations do not have access to counseling and testing programs because limited funds cannot support them. "But this study shows that such services should be routine and available everywhere," he said.

Coates was a principal investigator on "The Voluntary HIV Counseling and Testing Efficacy Study," the basis of several presentations here at the 12th World AIDS Conference.

The largest study of its kind, the research is a collaborative project of the UCSF ARI and several international organizations. Researchers looked at how providing free HIV counseling and testing services in three developing countries could influence the practice of unprotected sex by individuals and couples. Gloria Sangiwa of the University of Dar Es Salaam presented study results today (June 29) focused on individuals who had completed six months of personal counseling about high-risk sexual behavior for exposure to HIV. Coates will present additional data from the study on July 1 that focuses on couples who had completed six months of counseling.

The project is the first randomized study to look at the developing world, encompassing three countries in Africa and the Caribbean, and more than 5000 participants.

The team set up free counseling centers easily accessible to local residents of Nairobi, Kenya; Dar Es Salaam, Tanzania; and Port-of-Spain, Trinidad and Tobago. The researchers selected 3120 individuals and 586 couples responding to advertisements about the study. These participants were then randomly assigned to receive either counseling/testing services or "standard health information" consisting of videotaped information about sexually transmitted diseases and a supply of condoms.

All the participants were invited to return to the centers six and 12 months later to take part in counseling and testing.

"There was concern about attracting a low-risk group of the 'worried well,' but we were very successful at reaching a high-risk group," Coates said. "Thirty percent of the women and 15 percent of the men seen in these clinics were HIV-positive.2

"We saw up to a 50 percent reduction in risk behavior in six months, and there was a clear difference in individual behaviors after counseling," he said. "For the couples, the behavior changes depended on whether the partners were the same serostatus or not."

Six months after the counseling intervention, study findings showed:

  • Overall rates of unprotected sex dropped for all participants, regardless of whether the partner was a primary partner, a non-primary partner, or a commercial sex provider.
  • The most dramatic reductions were seen with men having unprotected sex with a non-primary partner. The overall rate decreased from 31 percent before counseling to 19 percent six months after counseling. The health-information only group began at 30 percent and dropped to 26 percent six months later.
  • Women reported more unprotected sexual encounters with a primary partner and fewer with a non-primary partner or a commercial partner than the men, both before and after intervention.

THE FOLLOWING INFORMATION IS EMBARGOED UNTIL 11:00 PM (PACIFIC STANDARD TIME), ON TUESDAY, JUNE 30, 1998 OR 8:00 AM (GENEVA TIME), ON WEDNESDAY, JULY 1, 1998:

Study findings about the couples who took part in six months of counseling include:

  • Of the 429 married couples completing testing and counseling, 78.8 percent had the same HIV status (seroconcordant), 72.3 percent were both negative, and 6.5 percent were both positive.
  • Of the 21.3 percent who were not of the same HIV status (serodiscordant), 11.3 percent were male-negative/female-positive and 10 percent were male-positive/female negative.
  • The most dramatic decrease in rates of unprotected intercourse with a spouse occurred in the group in which men were HIV-positive and women were HIV-negative. This rate dropped from 100 percent to 45 percent.
  • When both partners were positive, the rate of unprotected intercourse with each other also decreased significantly, from 75 percent before counseling to 38 percent six months later.
  • Unprotected sex with other partners increased from 11 percent to 15 percent in all couple groups.
"These findings definitely answer the question that counseling and testing is not only effective, but also cost-effective in these countries," Coates said. "And the money that would be spent is small compared to the magnitude of the problem."

In addition to Coates and Sangiwa, study co-investigators are Don Balmer of the Kenya Association of Professional Counselors and Colin Furlong of the Queens Park Counseling Center of Port-of-Spain.

Other collaborators include M. Claudes Kamenga of Family Health International and the Johns Hopkins University School of Public Health, Eric von Praag of the World Health Organization, Samuel Kalibala of the United Nations joint program on AIDS, and Olga Grinstead of the UCSF ARI.

The UCSF ARI is an institute without walls that encompasses all UCSF AIDS programs under a single umbrella. The UCSF ARI includes a dozen research institutes, a wide range of clinical, behavioral science, and policy programs, and nearly 1,000 investigators.

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