What Works for Women and Girls

to those who received health education. Individuals reporting unprotected intercoursewith non-primary partners declined by 35% for men who received VCT as compared to13% for those receiving health information and by 39% for women who received VCTas compared to 17% who received health education. Individual men who had receivedVCT reduced the mean number of non-primary partners with whom participants hadunprotected intercourse from 38% to 15% and women reduced the mean number ofnon-primary partners with whom participants had unprotected intercourse from 43%to 22%. VCT was based on a client-centered counseling model, including personal riskassessment and developed of a personalized risk reduction plan. Participants in thehealth information intervention watched a 15-minute video and participated in a discussionabout HIV transmission and condom use. All precipitants received free condomsand a brochure showing correct condom use. Urine samples were taken to assess ifSTIs were new infections. A total of 3,120 individuals and 586 couples were enrolled inKenya, Tanzania and Trinidad (Voluntary HIV-1 Counseling and Testing Efficacy StudyGroup, 2000) (Gray II) (counseling, HIV testing, education, sex behavior, condom use,Tanzania, Kenya, Trinidad)A systematic review of the efficacy of VCT in Rwanda, Kenya, Tanzania, Trinidad,Thailand and Uganda settings in studies from 1990 to 2005 found that a significantincrease in condom use was reported in four studies conducted in free-standing VCTcenters, antenatal clinics, and STI clinics. One study found significant reduction in HIVincidence among ANC women whose partners also underwent VCT. The randomizedcontrol design showed a significant decrease in unprotected sex among, a) individualswith non-primary partners, and b) between couples when they were tested together.VCT was shown to promote the most behavior change between couples tested together,and among HIV-positive individuals, especially with their non-primary partners. Thereview used a standardized protocol. Studies were included where the intervention usedCDC or WHO VCT standards; was published between 1990 and 2005, were conductedin a developing country, and used a pre/post or multi-arm study design. Nine articlesfrom six studies were identified. Designs were 1) randomized controlled trial, 2) pre/post studies, and 3) post-intervention only assessments. (Denison et al., 2008). (GrayII) (counseling, HIV testing, couples, sex behavior, Rwanda, Kenya, Tanzania, Trinidad,Uganda)A cross-sectional and nationally representative study from 2004 to 2005 in Ugandaof 1,092 HIV-positive people, 64% female, from a HIV/AIDS Sero-Behavioral Surveywhich tested 18,525 adults found that knowledge of one’s HIV status, both one’s ownand one’s partner’s, was associated with increased condom use. Those who knew theirHIV status were three times more likely to use a condom at last sex encounter andthose who knew their partners’ HIV status were 2.3 times more likely to use condoms.Of all sexually active HIV-positive adults, 80% reported only one sexual partner in theprevious year. Within the subset of married HIV-positive persons, 86% reported havinghad sex only with their spouses in the last year, including 75% of men and 96% of152 CHAPTER 6 HIV TESTING AND COUNSELING FOR WOMEN