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In their article ‘How do HIV-negative individuals in sub-Saharan Africa change their sexual risk behavior upon learning their serostatus? A systematic review’ Ramachandran and colleagues address a critical public health question.1 They review articles that compare the sexual behaviours of HIV-uninfected adults before and after HIV testing to assess whether HIV testing lowers HIV acquisition risk. They include articles from Southern and Eastern Africa from 2003 to 2013, the first 10 years of the President's Emergency Plan for AIDS Relief, when HIV testing and the larger HIV response were being scaled up in the region.2
It is remarkable that there is a need for this review—that in 2016 the answer to this seemingly simple question is not known. Several reviews addressed this question in earlier periods and found that HIV-uninfected persons who test alone do not consistently change their behaviour, but HIV-uninfected persons in HIV-discordant relationships who undergo couple HIV counselling and testing (CHCT) do change their behaviour, especially increasing their condom use.3–5
In Ramachandran's review, …
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