Efficacy of Voluntary HIV-1 Counseling and Testing in Individuals and Couples in Kenya, Tanzania, and Trinidad: A Randomised Trial [Lancet 2000; 356: 103]: This is a report from the "Voluntary HIV-1 Counseling and Testing Efficacy Study Group" headed by Tom Coates, who examined the effectiveness of voluntary HIV-1 counseling and testing in promoting safe sex. Participants were randomly assigned to receive either counseling and testing or basic health information. The latter involved a 15-minute video followed by a discussion about HIV transmission and safe sex. The voluntary counseling and testing included a personalized risk assessment with development of a personalized risk-reduction plan for each participant. The counseling and testing group had superior outcomes in terms of the number per reporting reductions in unprotected sex at the first follow-up at an average of 7.3 months - 35% versus 13% for men and 39% versus 17% for women. These results were maintained at the second follow-up at an average of 13.9 months. The authors concluded that this type of voluntary counseling and testing has a significant benefit in reducing high-risk behavior.
Comment: A disappointing feature of the study is the lack of serologic testing to show a reduction in HIV incidence. The authors explained that their study was not powered to show this result. Despite this minor concern, the overall results embellished those of the report above in supporting voluntary counseling and testing as a mechanism to reduce risk for HIV in developing countries. posted 7/19/2000