United Press International - Sunday, 9 July 2000
Michael Smith, UPI Science News

Such programs are cheap and work well, especially in places where AIDS is highly prevalent, said Thomas Coates of the San Francisco AIDS Research Institute.

Coates said a study conducted in Kenya, Tanzania and Trinidad showed that people who were given HIV testing and counseling reduced their risky sexual behavior "dramatically" compared to people in the control group.

The study was undertaken at the request of organizations such as the World Health Organization and the National Institutes of Mental Health, he said, to see if voluntary counseling and testing (VCT) was a suitable use of anti-AIDS funding.

The conclusion was that "VCT should be provided widely," Coates said at a press conference to publicize the study, published July 8 in the British medical journal "The Lancet.''

A related study examining the cost-effectiveness of VCT, by Michael Sweat of Johns Hopkins University in Baltimore, Md., showed that HIV infections could be averted by VCT at a cost of between $250 and $350 per case.

If the programs in Kenya and Tanzania each covered 10,000 clients, Sweat said, they would have cost about $230,000 a year, but would have averted between 800 and 1,100 HIV infections in each country.

Coates said the programs enrolled 3,120 individuals and 586 couples, in their late 20s or early 30s, between 1995 and 1997. Cost of the program was about $29 for each client.

At the first stage of the study, they were questioned about their sexual behavior and other health issues before being assigned randomly to two groups. One group -- the health information arm -- was shown a video about AIDS, offered condoms, and got answers to any questions they had.

The others-the VCT group -- had blood drawn for HIV testing and returned two weeks later for test results followed by counseling on what they could do to change their behavior to reduce risk either to themselves or to others.

Six months after the initial interview, both groups returned for a follow-up interview and the health information group was offered HIV testing and counseling, Coates said. More than 90 per cent of the health information group agreed to have an HIV test, Coates said, proving that "people do want VCT."

But in a key indicator, he said, was that people, both individuals and couples, in the VCT group reduced risky behavior sharply.

For instance, Coates said, individual clients reported a 33 per cent drop in unprotected sex with what he called "non-primary" partners. By contrast, individuals in the health information group reported only a slight reduction -- about 10 per cent -- in unprotected sex with a non-primary partner.

The results were similar for couples, he said.

"This is a profound drop in risk behavior," he said.

Coates said VCT has a "huge psychological benefit" in reducing uncertainty, even though for many people in the developing world, no treatments are available. He added that knowing HIV status allows people to change their behavior to protect themselves and others.

"If you can get someone to change their behaviour, you can prevent a lot of infections," Coates said.
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