HIV testing increases condom use
HIV Testing and Counseling Leads to Immediate Consistent Condom Use among South African Stable HIV-Discordant Couples
Rosenberg NE, Pettifor AE, Bruyn GD, Westreich D, Delany-Moretlwe S, Behets F, Maman S, Coetzee D, Kamupira M, Miller WC. J Acquir Immune Defic Syndr. 2013 Feb 1;62(2):226-233. doi: 10.1097/QAI.0b013e31827971ca.
Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples. Partners in Prevention HSV/HIV Transmission Study was a randomized trial conducted from 2004 to 2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1-coinfected persons to HIV-uninfected sex partners. This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants. The exposure was timing of first HIV testing and counseling: 0-7, 8-14, 15-30, or >30 days before baseline. In each exposure group, predicted probabilities of unprotected sex in the last month were calculated at baseline, month 1, and month 12 using generalized estimating equations with a logit link and exchangeable correlation matrix. At baseline, participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month: 0-7 days, 0.71; 8-14 days, 0.52; 15-30 days, 0.49; >30 days, 0.26. At month 1, once all participants had been aware of being in HIV-discordant relationships for ≥1 month, predicted probabilities declined: 0-7 days, 0.08; 8-14 days, 0.08; 15-30 days, 0.15; >30 days, 0.14. Lower predicted probabilities were sustained through month 12: 0-7 days, 0.08; 8-14 days, 0.11; 15-30 days, 0.05; >30 days, 0.19. Unprotected sex declined after HIV-positive diagnosis and declined further after awareness of HIV discordance. Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk.
Editor’s notes: Adoption of condom use based upon IEC and BCC campaigns has proven challenging in many settings: self-assessment of HIV risk has not coincided well with actual risk. This study reinforces the information that at least within the context of stable HIV-discordant the self-report of condom use dramatically rises from pre-testing rates of condom use. Of course there are biases in studies that rely on self-report- with a suggestion that socially ‘acceptable’ responses may be over-reported, but this study does join the body of knowledge on the impact of couples counseling and testing. As with the other study cited in this issue, challenges remain with promoting consistent and correct condom use during sex outside the setting of the stable couple. Despite the methodological concerns, this study reinforces couples counseling strategies, and highlights that mutual awareness seems to lead to successful adoption of HIV prevention behaviours.