Voluntary counseling and testing for couples: a high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa
Section snippets
HIV/AIDS in sub-Saharan Africa
23.3 million persons in sub-Saharan Africa were living with HIV infection or AIDS by the end of 1999, accounting for nearly 70% of the estimated 33.6 million individuals living with HIV/AIDS worldwide (UNAIDS/WHO, 1999). The vast majority of these persons were infected during heterosexual intercourse (Allen et al., 1992b; Berkley, 1994). During 1999 nearly 90% of the 571,000 children born or infected with HIV-1 through breast-feeding were living in sub-Saharan Africa. The mothers of these
Media-based interventions
Broad-based HIV/AIDS information programs, be they referred to as Information Education and Communication (IEC) or Communications for Behavior Change, and which use the electronic and (to a lesser extent) printed media to promote HIV/AIDS awareness and behavior change, have been common in sub-Saharan Africa since the mid-1980s. Typically these programs are directed toward an undifferentiated public or categories of individuals that are identified as more inclined to engage in higher-risk sexual
VCT studies and interventions from 1990 to 1997
VCT has received considerable scrutiny in the scientific literature during the 1990s. Reviews (e.g., Beardsell, 1994; Beardsell & Coyle, 1996; Campbell et al., 1997; Choi & Coates, 1994; Gerber, Campbell, Dillon, & Holtgrave, 1994; Higgins et al., 1991; Irwin, Valdiserri, & Holmberg, 1996; Oakley, Fullerton, & Holland, 1995; Wolitski, MacGowan, Higgins, & Jorgensen, 1997) and studies in African and non-African settings have assessed the effectiveness of VCT in reducing risk behaviors and
Accumulating evidence that VCT works and is cost-effective
Studies in sub-Saharan Africa during the 1990s produced evidence indicating, albeit somewhat inconsistently, that VCT can be effective as a HIV-prevention tool, particularly when members of couples participated together in the VCT process. Evidence of VCT-induced HIV risk reductions and rates of HIV seroconversion was particularly strong in the case of HIV serodiscordant couples. Regardless of study results, however, investigators were nearly unanimous in noting that VCT for couples may be a
Intervention processesStrengthen VCT procedures, staff capacity & performance Target couples in VCT recruitment efforts. The prevention potential of VCT for couples in Africa can be realized only if more couples learn about and gain access to VCT. Components of a more specialized VCT package for couples would include:
Strengthen VCT procedures, staff capacity & performance Target couples in VCT recruitment efforts. The prevention potential of VCT for couples in Africa can be realized only if more couples learn about and gain access to VCT. Components of a more specialized VCT package for couples would include:
- •
Frequent, clear and accurate media-based information programs using multiple languages are needed to increase access to information on VCT, with particular attention to the importance of VCT for couples for preventing both heterosexual and mother–child HIV transmission.
- •
Community outreach to couples in areas surrounding VCT facilities. This interactive approach is needed as a follow-on and complement to media-based information programs. Specific approaches need to be developed through pilot
Conclusion
This paper has provided a brief overview of results from recent research and HIV prevention interventions in sub-Saharan that focus on couples and HIV risks, VCT, and in particular, VCT for couples. It has been proposed that the growing body of research and program evidence from sub-Saharan Africa which is supportive of VCT for couples as a HIV prevention tool, together with an increasingly supportive international policy environment for VCT, have created a unique sociological conjuncture for
Acknowledgements
The author wishes to thank Carl Campbell, Tim Dondero, Lynda Doll and several anonymous reviewers for their helpful comments on earlier drafts of this paper, however the author accepts sole responsibility for the form and content of the current version. The views expressed herein are those of the author alone and do not necessarily reflect those of the Centers for Disease Control and Prevention.
References (115)
- et al.
A review of research on the nature and quality of HIV testing servicesA proposal for process-based studies
Social Science & Medicine
(1996) - et al.
Transforming AIDS prevention to meet women's needs. A focus on developing countries
Social Science and Medicine
(1995) - et al.
The social impact of HIV infection on women in Kigali, RwandaA prospective study
Social Science & Medicine
(1994) - et al.
Anthropology and AIDSThe cultural context of sexual risk behavior among urban Baganda women in Kampala, Uganda
Social Science and Medicine
(1993) - et al.
African women's control over their sexuality in the era of AIDS
Social Science and Medicine
(1993) - et al.
Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, ThailandA randomized controlled trial
Lancet
(1999) - et al.
Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV in Kenya and Tanzania
Lancet
(2000) - AIDS Information Centre. (1994). Impact of social support club following HIV counseling and testing in Kampala, Uganda....
- et al.
Confidential HIV testing and condom promotion in AfricaImpact on HIV and gonorrhea rates
Journal of the American Medical Association
(1992) - et al.
Effect of serotesting with counseling on condom use and seroconversion among HIV discordant couples in Africa
British Medical Journal
(1992)