Characteristics of Individuals and Couples Seeking HIV-1 Prevention Services in Dar Es Salaam, Tanzania: The Voluntary HIV-1 Counseling and Testing Efficacy Study

The objective of this paper is to describe the baseline characteristics, risk behavior, and HIV prevalence of individuals and couples who enrolled in the Voluntary HIV Counseling and Testing Efficacy Study at the study site in Dar es Salaam, Tanzania. Participants were recruited through flyers, radio, and outreach to schools and workplaces to participate in a randomized clinical trial testing the effectiveness of HIV voluntary counseling and testing (HIV VCT) for prevention of new HIV and STD infections. Recruitment was stratified to include men and women enrolling alone and as couples. Baseline data were collected in face-to-face interviews, then participants were randomized to receive HIV VCT or health information. A total of 1,427 participants were recruited, 708 women and 719 men; 444 participants enrolled as part of a couple. HIV seroprevalence for those who received VCT at baseline was 21% overall (12% men, 30% women). Those enrolled as couples reported less sexual risk behavior than those enrolled as individuals. Both couples and individuals reported high rates of unprotected sexual intercourse with commercial partners. Overall 45% of participants self-reported an STD symptom (54% of women and 36% of men), and men were more likely to have received treatment for their symptoms. A large number of individuals and couples responded to advertisements for VCT in Dar es Salaam, Tanzania. High rates of HIV seroprevalence and couple serodiscordance, self-reported STD symptoms, and sexual risk behavior indicate that at-risk participants were recruited. Implications for delivery of HIV VCT and related services are discussed.     

Characteristics of Individuals and Couples Seeking HIV-1 Prevention Services in Nairobi, Kenya: The Voluntary HIV-1 Counseling and Testing Efficacy Study

This paper describes the recruitment and baseline characteristics of men, women, and couples who enrolled in the Voluntary Counseling and Testing Efficacy Study at the study site in Nairobi, Kenya. The purpose of this study was to test the effectiveness of Voluntary HIV Counseling and Testing (HIV VCT) to reduce sexual risk behavior. Between June 1995 and March 1996, 500 individual men, 500 individual women, and 515 couple members were recruited for a total sample of 1,515 participants. Participants were young (average age 29 years) and of low income. High levels of risk behavior and self-reported STD symptoms and a high rate of HIV seropositivity among those tested at baseline (15% of men and 27% of women) indicate that an at-risk sample was recruited. Women and participants reporting symptoms of a sexually transmitted infected were significantly more likely to be infected with HIV. Findings suggest that HIV VCT services combined with STD diagnosis and treatment and economic development services could motivate more at-risk individuals and couples to receive counseling and testing.     

The associations of voluntary counseling and testing acceptance and the perceived likelihood of being HIV-infected among men with multiple sex partners in a South African township

This paper examines the socio-demographic factors and sexual risk behaviors (condom use, number of sexual partners, STI symptoms) associated with voluntary counselling and testing (VCT) acceptance and self-perceived risk of being HIV-infected among black men with multiple and younger sex partners in a South African township outside of Cape Town. Using respondent driven sampling, we interviewed 421 men, of whom 409 (97.3%) consented to provide a dried blood spot, 12.3% were HIVinfected (95% confidence intervals [CI.] 8.3, 16.9) and 47.2% (CI. 41.1, 53.6) accepted on site VCT. Twenty six percent (CI. 20.2, 30.7) reported having an HIV test in the past year. Few men perceived themselves as very likely to be infected with HIV (15.6%; CI. 10.4, 20.5). VCT acceptance was significantly associated with being older, married or living with a partner, having higher education, having four to six partners in the past three months and testing HIV positive. Self-perceived likelihood of being HIV infected was significantly associated with low condom use and having seven or more partners in the past three months, and testing HIV positive. These findings indicate that men correctly understand that engaging in certain HIV risk behaviors increases the likelihood of HIV-infection. However, those who perceive themselves at high risk of having HIV do not seek testing. Further investigation into the psychological and cultural barriers to reducing risky sexual behaviors and accessing VCT and other HIV services is recommended.     

HIV Voluntary Counseling and Testing Service Preferences in a Rural Malawi Population

Voluntary counseling and testing (VCT) services have become an integral component of HIV prevention efforts in sub-Saharan Africa. This study of a rural Malawi district population examined variation in past and desired use of VCT services among 868 women aged 15 to 34 and 648 men aged 20 to 44 aware of HIV/AIDS. Only 11% of men and 7% of women had been tested, but of those untested, 76% of men and 61% of women desired testing. Ninety percent of respondents willing to know their results preferred to hear them from a test site counselor and on the same day of the test. However, 27% of women wanting to be tested did not want to know their test results, a finding significantly associated with knowing someone affected by AIDS and perceiving oneself at HIV infection risk. Knowledge of the behaviors of HIV prevention, knowing someone with AIDS, knowing the locations of a test site, and perceived risk of HIV infection all had a consistently significant association with past and future VCT use for men and women.     

Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs

This study aimed to describe the prevalence and predictors for male partner participation in HIV voluntary counselling and testing (VCT) at two primary healthcare clinics in Moshi urban, Tanzania as well as the effect of partner participation on uptake of HIV perinatal interventions. Pregnant women (n = 2654) in their third trimester, participating in a prevention of mother to child tranmission (PMTCT) program between June 2002 and March 2004 were encouraged to inform and invite their partners for HIV-VCT. Trained nurses conducted pre-test counselling, interviews, clinical examinations and blood sampling from the participating women and their partners. Test results were presented and post-test counselling was conducted individually or in couples, depending on the wishes of the participants. Three-hundred-and-thirty-two male partners (12.5%) came for HIV-VCT. A high proportion (131; 40%) came after the woman had delivered. HIV-seropositive women whose partners attended were three times more likely to use Nevirapine prophylaxis, four times more likely to avoid breastfeeding and six times more likely to adhere to the infant feeding method selected than those whose partners didn't attend. Women were more likely to bring their partner for VCT if they collected their own test results, were living with their partner, had a high monthly income and had expressed at enrolment the intention to share HIV results with their partner. Although PMTCT programs are presumably a good entry point for male involvement in prevention of sexual and perinatal HIV transmission, this traditional clinic-based approach reaches few men. Given the positive influence male participation has on the acceptance of perinatal interventions, a different approach for promoting male participation in VCT is urgently required. Within PMTCT programs, counseling should emphasize the advantages of partner participation to encourage women to inform and convince male partners to come for VCT. Also, promotion of couple VCT outside antenatal settings in male friendly and accessible settings should be given priority.     

Sexual Risks Among Southern Thai Drug Injectors

Sexual risks for HIV transmission among injection drug users (IDUs) in Thailand are not well characterized. We surveyed 272 male IDUs about their background, sexual behaviors, and drug use at drug treatment clinics in southern Thailand. HIV seroprevalence was determined using enzyme immunoassay. Fifty-six percent of participants were sexually active, of whom 88% had sex mostly with a noninjecting regular partner (wife or steady girlfriend), reporting low rates (34%) of condom use. Among sexually active IDUs, 43% were HIV infected and only a few were aware of their HIV serostatus. Condom use was associated with history of HIV voluntary counseling and testing (VCT) and poor perceived health status in multivariate analysis. Unprotected sex with regular sexual partners is frequent among IDUs in southern Thailand, where most IDUs have not sought VCT services. AIDS prevention efforts should address access to VCT and condom promotion to sexually active couples to prevent sexual transmission of HIV.     

2008-2011年上海市长宁区VCT情况分析

目的分析上海市长宁区艾滋病自愿咨询检测（VCT）人群相关情况,以及艾滋病病毒（HIV）抗体检测和部分人群梅毒检测结果,为今后艾滋病性病防治干预工作提供科学的依据。方法搜集2008-2011年上海市长宁区疾病预防控制中心VCT门诊求询者的基本信息,以及HIV抗体及部分求询者梅毒检测结果等资料进行统计学分析。结果 2008-2011年,长宁区疾病预防控制中心VCT门诊接受咨询检测服务共计3 382人,求询者男女性别比为11.6∶1;求询者以25～44岁的青壮年人群为主,占66.74%（2 257/3 382）。求询者均有性接触史（非婚异性性行为、男男性行为、配偶/固定性伴阳性）,且男男性行为人群（MSM）比例呈逐年上升趋势。求询者中曾经接受过HIV抗体检测所占比例总体呈上升趋势（z=18.854,P〈0.000 1）;2008-2011年,96.24%（3 255/3 382）的求询者接受了HIV抗体检测,且阳性率呈逐年升高的趋势（z=5.680 5,P〈0.000 1）。HIV抗体阳性人群中,配偶/固定性伴阳性者及MSM人群阳性率较高,分别为10.53%（8/76）、7.45%（89/1 195）,其中MSM人群HIV抗体阳性率总体呈上升趋势。同时接受HIV和梅毒抗体检测的1 713名求询者中,梅毒抗体阳性人群的HIV阳性率为24.62%（16/65）,梅毒抗体阴性人群的HIV抗体阳性率为4.49%（74/1 648）,两者之间的差异有统计学意义（χ2=50.88,P〈0.000 1）。结论今后的工作重点在于加强对配偶/固定性伴阳性者的知识宣传和行为干预,尽早发现感染者,减少二代传播;MSM人群的干预以及其阳性感染者获得很好的后续服务及管理,也是今后干预工作的一项重要内容。     

High Rates and Positive Outcomes of HIV-Serostatus Disclosure to Sexual Partners: Reasons for Cautious Optimism from a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania

The rates, barriers, and outcomes of HIV serostatus disclosure to sexual partners are described for 245 female voluntary counseling and testing (VCT) clients in Dar es Salaam, Tanzania. VCT clients were surveyed 3 months after HIV testing to describe their HIV-serostatus disclosure experiences. Sixty-four percent of HIV-positive women and 79.5% of HIV-negative women (p = 0.028) reported that they had shared HIV test results with their partners. Among women who did not disclose, 52% reported the reason as fear of their partner's reaction. Both 81.9% of HIV-negative women and 48.9% of HIV-positive women reported that their partner reacted supportively to disclosure (p < 0.001). Less than 5% of women reported any negative reactions following disclosure. VCT should continue to be widely promoted. However, intervention approaches such as development of screening tools and new counseling approaches are important to ensure the safety of women who want to safely disclose HIV serostatus to their sexual partners.     

Personal History of Voluntary HIV Counseling and Testing (VCT) Among Adults Aged 19–35 Years Living in Peri-urban Communities,Chiang Mai,Northern Thailand

This study investigates the self-reported history of HIV voluntary counseling and testing (VCT) among adults, aged 19–35 years, in northern Thailand. Participants were interviewed about their HIV testing history and risk behavior. Overall, 47% of 2251 participants had previously been tested, of whom 64% were tested at government clinics. Of those tested at private clinics, 50% reported not receiving pre- and post-test counseling, compared to 15% of those tested in government clinics. Ten percent of those tested had not received their test results. Among those who had never been previously tested for HIV, 66% believed they were not at risk, although 1.5% (2.7% among men) were HIV infected. Although VCT is widely available and utilized by the population of northern Thailand, substantial numbers of HIV infected persons have not been tested for HIV and among those tested many have not received comprehensive counseling. A Thai government policy enforcing effective counseling to accompany HIV testing is urgently needed.     

Empowering HIV testing as a prevention tool: targeting interventions for high-risk men who have sex with men

In France, HIV testing can be easily performed in free and anonymous voluntary counselling testing (VCT) centres. The recent national study among French men who have sex with men (MSM) showed that 73% of those already tested for HIV had been tested in the previous two years. Nothing is known about the risk behaviours of MSM attending VCT centres. This study aimed to characterize sexual risk behaviours of MSM tested for HIV in such centres and identify factors associated with inconsistent condom use (ICU). A cross-sectional study was conducted from March to December 2009 in four VCT centres where a self-administered questionnaire was proposed to all MSM about to have a HIV test. ICU was defined as reporting non-systematic condom use during anal intercourse with casual male partners. Among the 287 MSM who fully completed their questionnaire, 44% reported ICU in the previous six months. Among those who had been already tested, 63% had had their test in the previous two years. Factors independently associated with ICU included: never avoiding one-night stands, not having been recently HIV tested, experiencing difficulty in using condoms when with a HIV negative partner or when under the influence of drugs or alcohol and finally, reporting to have had a large number of casual male partners in the previous six months. The rate of recently tested MSM was high in our study. Nevertheless, this rate was lower than that found in the last national study. Furthermore those not recently tested were significantly more likely to report high risk behaviours. We therefore recommend that further efforts be made to adapt the offer of both HIV testing and counselling to meet the specific needs of hard-to-reach MSM. Accordingly, an additional community-based offer of HIV testing to reach most-at-risk MSM is forthcoming in France.     

Clients' Perspective of the Role of Voluntary Counseling and Testing in HIV/AIDS Prevention and Care in Dar Es Salaam, Tanzania: The Voluntary Counseling and Testing Efficacy Study

There is a growing body of evidence that voluntary HIV counseling and testing (VCT) is effective for the primary prevention of HIV as well as for the care and support of individuals affected by HIV in developing countries. This qualitative study offers an additional perspective: the experiences and perceptions of men and women receiving VCT services. As a substudy of a large multisite clinical trial testing the effectiveness of VCT, 81 study participants at the Tanzania study site who were randomized to VCT at baseline were interviewed at the time of their 6-month follow-up. Findings are based on textual analysis of the following themes: HIV in the context of other life issues, motivations for receiving services, positive and negative consequences of VCT, and the role of VCT in risk reduction. Implications for service provision in developing countries are discussed.     

Uptake of HIV voluntary counselling and testing services in rural Tanzania: implications for effective HIV prevention and equitable access to treatment

Objective To describe the associations between socio‐demographic, behavioural and clinical characteristics and the use of HIV voluntary counselling and testing (VCT) services among residents in a rural ward in Tanzania. Methods Eight thousand nine hundred and seventy participants from a community‐based cohort were interviewed, provided blood for research HIV testing, and were offered VCT. Univariate and multivariate logistic regression was used to identify socio‐demographic, clinical and behavioural factors associated with VCT use. Results Although 31% (1246/3980) of men and 24% (1195/4990) of women expressed an interest in the service, only 12% of men and 7% of women subsequently completed VCT. Socio‐demographic factors, such as marital status, area of residence, religion and ethnicity influenced VCT completion among males and females in different ways, while self‐perceived risk of HIV, prior knowledge of VCT, and sex with a high‐risk partner emerged as important predictors of VCT completion among both sexes. Among males only, those infected with HIV for 5 years or less tended to self‐select for VCT compared to HIV‐negatives (adjusted odds ratio = 1.43; 95% CI: 0.99–2.14). This contributed to a higher proportion of HIV‐positive males knowing their status compared to HIV‐positive females. Conclusions In this setting, a disproportionate number of HIV‐positive women are failing to learn their status, which has implications for equitable access to onward referral for care and treatment services. Evidence that some high‐risk behaviours may prompt VCT use is encouraging, although further interventions are required to improve knowledge about HIV risk and the benefits of VCT. Targeted interventions are also needed to promote VCT uptake among married women and rural residents.     

Factors Related to Female Sex Workers’ Willingness to Utilize VCT Service: A Qualitative Study in Jinan City, Northern China

While national HIV prevalence remains low in China, female sex workers (FSWs) have become infected at high rates. Free voluntary HIV counseling and testing (VCT) has been offered in recent years; however, its utilization rate is low. This study explored factors related to FSWs’ willingness to utilize a VCT clinic. Qualitative interviews informed by the Ecological Perspective were conducted to interview 17 FSWs and 12 managers from 23 selected entertainment establishments in Jinan, the capital of Shandong province in northern China. While the majority of FSWs professed willingness to use VCT services, they described barriers to actual utilization of services which included: misunderstandings about HIV; low perceived risk and HIV prevalence; mistrust of the free VCT; and especially anxiety about the implications of possible test results. This research suggests that increasing FSWs’ utilization of VCT will require increased knowledge of HIV and VCT, and acceptance of testing and on-site VCT services.     

Women's barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing

In view of the ever-increasing HIV/AIDS epidemic in sub-Saharan Africa, the expansion of HIV-1 voluntary counselling and testing (VCT) as an integral part of prevention strategies and medical research is both a reality and an urgent need. As the availability of HIV-1 VCT grows two limitations need to be addressed, namely: low rates of HIV-1 serostatus disclosure to sexual partners and negative outcomes of serostatus disclosure. Results from a study among men, women and couples at an HIV-1 VCT clinic in Dar es Salaam, Tanzania are presented. The individual, relational and environmental factors that influence the decision to test for HIV-1 and to share test results with partners are described. The most salient barriers to HIV-1 testing and serostatus disclosure described by women include fear of partners' reaction, decision-making and communication patterns between partners, and partners' attitudes towards HIV-1 testing. Perception of personal risk for HIV-1 is the major factor driving women to overcome barriers to HIV-1 testing. The implications of findings for the promotion of HIV-1 VCT programmes, the implementation of partner notification policies and the development of post-test support services are discussed.     

Cost-effectiveness of counseling and testing and partner notification: a decision analysis.

OBJECTIVE: Counseling and testing and partner notification are effective HIV prevention strategies, but they can be resource intensive. This paper evaluates the cost-effectiveness of partner notification and counseling and testing offered in HIV and sexually transmitted disease (STD) clinics in preventing future HIV infections in the United States of America. METHODS: Decision trees were developed from both societal and provider perspectives. The counseling and testing and partner notification models incorporate estimates of HIV prevalence, return rates for counseling, risk of HIV transmission within 1 year, and the effectiveness of counseling. Cost estimates for counseling and testing and partner notification programs and lifetime treatment cost of HIV for the United States of America were obtained from published literature. Extensive sensitivity analyses of model parameters were conducted. RESULTS: For a cohort of 10,000 individuals at a clinic with an HIV seroprevalence of 1.5%, we estimate that counseling and testing prevents eight HIV infections and saves society almost $1,000,000. We estimate that partner notification for the 113 infected persons identified by counseling and testing, prevents another 1.2 HIV infections and saves an additional $181,000. To the provider (HIV and STD clinics), this translates to a cost of $32,000 per case prevented by counseling and testing and an additional $28,000 for partner notification. Model results are most sensitive to assumptions of HIV prevalence, risk of transmission, and treatment cost of HIV. CONCLUSIONS: Counseling and testing and partner notification are cost effective in preventing HIV transmission in this setting. This model can be adapted to assess the cost-effectiveness of counseling and testing and partner notification in other settings.     

在性病门诊开展艾滋病自愿咨询检测工作及效果分析

目的通过艾滋病自愿咨询检测（VCT）及早发现、及时治疗艾滋病（AIDS）病人，并为求询者提供干预措施，降低感染危险和预防艾滋病病毒（HIV）的传播。方法在性病门诊设置艾滋病咨询室，提供规范的VCT服务。结果一年来，共为1921名求询者提供VCT服务，发现HIV／AIDS患者6例，阳性率为0．31％，与人群估计阳性率0．005％比较，经u检验，P〈0．0005。结论在性病门诊开展VCT服务，可以迅速吸引具有高危行为的人接受咨询检测，高效地发现阳性感染者。     

Recent HIV type 1 infection among participants in a same-day mobile testing pilot study in Zimbabwe

We estimated HIV-1 incidence and characterized risk factors associated with recent infection among participants of a mobile HIV voluntary counseling and testing (VCT) pilot program in two communities in Zimbabwe (N = 1096). HIV-1 infection was diagnosed using a parallel rapid testing algorithm. Recent HIV-1 infections were characterized using the BED immunoglobulin G capture enzyme immunoassay (BED-CEIA). HIV prevalence was 28.9% overall and nearly twice as high in women compared to men (39.5% vs. 21.4%, p < 0.001). HIV-1 incidence was 1.91% and was comparable between men and women (1.99% vs.1.88%; p = 0.626). Although not significant, the proportion of recent infections among all infections was highest among persons ages 25 to 34 years old (10.5%) for both men (11.9%) and women (9.2%). Persons recently infected compared to those with long-term infections were more likely to report STD symptoms (33% vs. 13%; OR = 3.2; p = 0.075) and prior STD treatment (13% vs. 6%; OR = 3.4; p = 0.187) in the previous 6 months. There were no associations found between recent versus long-term HIV infection status and perceived risk or expectation of negative test results. Recent HIV-1 infection detection among mobile VCT participants is a valuable measure for tracking the spread of the epidemic among persons who might otherwise not have access to HIV testing due to practical and logistical barriers. Mobile VCT presents opportunities to expand HIV testing services and evaluate at-risk populations within community settings. Given the challenges of longitudinal cohort studies, recent infection may be a practical endpoint for community-based prevention intervention trials employing mobile testing.     

HIV Voluntary Counseling and Testing and Behavioral Risk Reduction in Developing Countries: A Meta-analysis, 1990–2005

The effectiveness of HIV voluntary counseling and testing (VCT) in reducing HIV risk behaviors in developing countries was assessed using meta-analytic methods. A standardized protocol was used for searching, acquiring, and extracting study data and meta-analyzing the results. Seven studies met the inclusion criteria. VCT recipients were significantly less likely to engage in unprotected sex when compared to behaviors before receiving VCT, or as compared to participants who had not received VCT [OR 1.69; 95%CI 1.25–2.31]. VCT had no significant effect on the number of sex partners [OR 1.22; 95%CI 0.89–1.67]. While these findings provide only moderate evidence in support of VCT as an effective prevention strategy, neither do they negate the need to expand access to HIV testing and counseling services. Such expansion, however, must be accompanied by rigorous evaluation in order to test, refine and maximize the preventive benefits of learning one’s HIV infection status through HIV testing and counseling.     

湖北省2008-2010年VCT情况分析

目的分析湖北省2008-2010年艾滋病自愿咨询检测(VCT)情况,为制定艾滋病防治对策提供依据。方法对2008-2010年全省VCT门诊求询者的基本信息、艾滋病病毒(HIV)抗体检测情况及各类VCT门诊工作状况进行统计分析。结果 2008-2010年,到全省各级VCT门诊接受咨询检测的人数共计163 634人,男女性别比为1.34∶1;求询者以20～39岁青壮年为主,占73.48%;求询者类型以有非婚异性性行为史为主,且其构成比逐年上升。96.76%的求询者接受了HIV抗体筛查检测,筛查阳性率以配偶/固定性伴HIV抗体阳性者和有男男性行为史者两类人群为高,分别为8.52%和5.97%,与其他类型人群之间存在显著性差异。2008～2010年,各级医疗机构设立的VCT门诊数占VCT门诊总数的比例分别为64.86%、64.71%和70.06%,其咨询检测人数占VCT总人数的比例分别为39.59%、41.98%和47.55%。结论应进一步加强对配偶/固定性伴阳性和有男男性行为史人群的早期发现和干预工作,减少二代传播;同时应加快推进医疗机构医务人员主动提供的艾滋病检测咨询服务,充分发挥医疗机构的优势和作用。     

The HIV testing experiences of adolescents in Ndola, Zambia: do families and friends matter?

This study explored how adolescents involve their families, friends and sex partners when making decisions about seeking HIV voluntary counseling and testing (VCT) and disclosing their HIV-status. The study is based on 40 qualitative in-depth interviews with 16 to 19 year olds who knew their HIV status in Ndola, Zambia. The findings show that: a) almost half of the youth turned to family members for advice or approval prior to seeking VCT; b) a disapproving reaction from family members or friends often discouraged youth from attending VCTuntil they found someone supportive; c) informants often attended VCTalone or with a friend, but rarely with a family member; and d) disclosure was common to family and friends, infrequent to sex partners, and not linked to accessing care and support services. Family members need access to information on VCT so they can support young peoples' decisions to test for HIV and to disclose their HIV status. These results reinforce the need to provide confidential VCT services for adolescents and the need to develop and test innovative strategies to reach adolescents, their families and sex partners with VCT information and services.