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Botswana's Tebelopele Voluntary HIV Counseling and Testing Network: Use and Client Risk Factors for HIV Infection, 2000-2004

Creek, Tracy L MD*; Alwano, Mary Grace MPH; Molosiwa, Ronald R MSW; Roels, Thierry H MD*†; Kenyon, Tom A MD, MPH*†; Mwasalla, Vida; Lloyd, Ethleen S MS*†; Mokomane, Modisaotsile MSW; Hastings, Philip A PhD*; Taylor, Allan W MD, MPH*; Kilmarx, Peter H MD*†

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2006 - Volume 43 - Issue 2 - p 210-218
doi: 10.1097/01.qai.0000230525.71717.5d
Epidemiology and Social Science

Background: HIV services, including voluntary counseling and testing (VCT) and antiretroviral (ARV) therapy, expanded rapidly in Botswana from 2000 through 2004.

Methods: Client data from Botswana's Tebelopele VCT network were analyzed to describe clients, factors associated with HIV infection, and trends in VCT use.

Results: Tebelopele provided free, anonymous, same-day HIV tests for 117,234 clients from 2000 through 2004. Before ARV therapy was available, 8.3% of clients sought a test because of illness, and 26.3% were HIV-positive. After ARV therapy became available, 20.1% of clients sought a test because of illness, and 38.8% were HIV-positive. Most VCT clients (82.7%) were unmarried; 89.8% reported no or 1 sexual partner in the last 3 months; and 50.2% of unmarried clients reported always using condoms in the last 3 months. In multivariate analysis, higher educational level, marriage, and always using condoms were associated with a lower risk of HIV. Having only 1 recent sexual partner was associated with less condom use and a higher risk of being HIV-positive for men.

Conclusions: VCT has been well accepted in Botswana. Analysis of this data set supports efforts to promote 100% condom use and to emphasize that partner reduction must be combined with condom use and HIV testing to protect against HIV.

From the *Centers for Disease Control and Prevention, Atlanta, GA; and †BOTUSA Project, Gaborone, Botswana.

Received for publication November 18, 2005; accepted May 25, 2006.

Supported by the Centers for Disease Control and Prevention.

Use of trade names is for identification purposes only and does not imply endorsement by the US Department of Health and Human Services or the Public Health Service or by the Botswana Ministry of Health.

Reprints: Tracy Creek, MD, Centers for Disease Control and Prevention, Global AIDS Program, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA (e-mail: tgc0@cdc.gov).

© 2006 Lippincott Williams & Wilkins, Inc.