|The Impact of Voluntary Counselling and Testing: A global review of the benefits and challenges (UNAIDS, 2000, 96 p.)|
A randomized-controlled trial of VCT versus HIV education alone was carried out among students (Wenger et al., 1992303). When interviewed at six months follow-up, the students in the VCT group had increased communication with sexual partners about the risk of HIV infection. However, no consistent differences among the groups in the number of sexual partners or the use of condoms were found at follow-up.
STI clinic attendees
In another study carried out by the same group in Los Angeles the effect of VCT versus AIDS education was looked at among consecutive attendees at an STI clinic (Wengeret al., 1991304). At follow-up the mean number of sexual partners decreased, but there was no significant difference between the groups. However, the VCT group questioned their most recent sexual partner/s more about HIV (p=0.01), worried more about getting AIDS (P=0.03), and tended to use condoms more often with their last sexual partner (p=0.05). Of VCT subjects, 40% versus 20% of the information group used condoms, avoided genital intercourse, or knew that their last sexual partner had a negative antibody test (p=0.005).
Women clinic attendees
A study of women attending family planning and gynaecology outpatients revealed that being tested for HIV did not result in any significant changes in condom use, self-reports of STIs or number of sexual partners in the four months following testing (Wilson et al., 1996305).
Another study from the United States compared the effects of VCT on sexual behaviour among women attending four primary health care clinics (Icovics et al., 1994306). One hundred and fifty-two seronegative women and seventy-eight women who had never been tested (matched for age and race) were questioned about their sexual behaviour at two weeks and three months after the VCT baseline. There were no significant differences in the groups and no significant changes in risk behaviour in either group. The authors suggest that women who seek VCT may have already made changes in their sexual behaviour prior to requesting VCT.
A study assessing the free, anonymous, public VCT service at two sites in North Carolina, had disappointing results (Landis et al., 1992307). No significant changes were found in high-risk sexual behaviour at follow-up.
See under section 1 (Padian et al., 1987).
In these studies the prevalence of HIV was relatively low. There were no people with seropositive results who took part in the intervention groups in the studies by Wengeret al. In the study by Icovicset al., women were recruited from clinics in southern Connecticut, where there is little morbidity or mortality from HIV outside higher risk groups. This may mean that while women are willing to undergo testing they do not perceive themselves to be at significant risk from HIV and therefore do not feel it is necessary to make changes in their sexual behaviour. This emphasizes the difficulties in making comparisons between studies from low-prevalence industrialized countries and much higher-prevalence developing countries.