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Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda

Matovu, Joseph KBa; Gray, Ronald Hb; Makumbi, Fredricka; Wawer, Maria Jc; Serwadda, Davidd; Kigozi, Godfreya; Sewankambo, Nelson Ke; Nalugoda, Freda

Epidemiology and Social

Objective: To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda.

Methods: In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively.

Results: Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85–0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90–0.99) or higher (adj. RR = 0.91; 95% CI, 0.87–0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68–0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90–0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82–0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08–1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04–1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT.

Conclusion: In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.

From the aRakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda

bJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland

cMailman School of Public Health, Columbia University, New York, New York, USA

dInstitute of Public Health, Makerere University

eMakerere University, School of Medicine, Kampala, Uganda.

Received 22 June, 2004

Revised 1 November, 2004

Accepted 21 December, 2004

Correspondence to Ronald H. Gray, MD, MSc, Suite 4030, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.