What Works for Women and Girls

10. Counseling may reduce risk behaviors and HIV acquisition.A study of voluntary HIV counseling and testing in Tanzania found that a personalizedrisk reduction counseling session of 40 minutes was more effective in reducingrisk behaviors and STIs than watching a 15-minute video. Using information from theformative research, the counseling sessions entailed a personalized risk assessment anda personalized risk reduction plan based on level of knowledge, interpersonal situation,specific risk behaviors, and readiness to change. Participants were randomly assignedto receive either HIV counseling and testing or a health information interventionwhere participants watched a 15-minute video in the presence of a health informationofficer, who responded to their questions at the end. Couples were randomized togetherso that both members always received the same intervention. Participants enrollingas couples were counseled together or individually, depending on their choice. Eachcouple member was given individual time with the counselor. Test results were initiallygiven individually, and then the couple was encouraged to share their results in a jointcounseling session. Post-test counseling then proceeded with both members of thecouple. All participants were given condoms at no cost and tested for STIs and treatedas appropriate if found positive. A total of 1,427 participants were enrolled (500 men,489 women, and 222 couples). HIV prevalence among those assigned to received HIVcounseling and testing at baseline was 21%—13% for men and 29% for women. After6 months, although there was a reduction in risk behavior for both groups, individualswho received the counseling and testing intervention showed significantly reduced riskbehavior (26% to 16%) than those who received health information only (26% to 23%)(Kamenga et al., 2001). (Gray II) (counseling, HIV testing, sex behavior, couples, Tanzania)A prospective cohort study of 250 HIV-negative women and 250 HIV-negative men atincreased risk for HIV acquisition in India who received risk reduction counseling atthe start, six months later and twelve month later had low rates of HIV acquisition, andreported statistically significant reductions in the number of different sex partners, thenumber of new partners and the proportion of sexual encounters with nonprimary partners.Only two participants, one male and one female, seroconverted over 457 personyears of follow up. All attended an STI clinic and had VCT. To be considered high risk,all either had to have had five or more different sexual partners; had a diagnosed STI; orhaving had vaginal or anal sex with a known HIV-positive partner. Counseling coveredprevention techniques and reducing the number of partners. Condom use was demonstratedand condoms were provided free of charge. Condom use increased. Sessionslasted about one hour (Solomon et al., 2006). (Gray III) (sex behavior, sexual partners,counseling, HIV testing, India)WHAT WORKS FOR WOMEN AND GIRLS163