Abstract

Objective: To explore behaviour change, baseline risk behaviour, perception of risk, HIV disclosure and life events in health centre based Voluntary Counselling and Testing (VCT) clients.

Design and setting: Single-arm prospective cohort with before-after design at three (one urban and two rural) government health centres, study duration 2 years, 1999-2001.

Subjects: Consecutive eligible adult clients.

Main Outcome Measures: Numbers of sexual partners, partner type, condom use, reported STI symptoms, HIV disclosure and life events.

Results: High rates of enrolment and follow-up provided a demographically representative sample of 401 clients with mean time to follow-up of 7.4 months. Baseline indicators showed clients were higher risk than the general population, but reported a poor perception of risk. Clients with multiple partners showed significant reduction of sexual partners at follow-up (16% to 6%) p<0.001) and numbers reporting STI symptoms decreased significantly too (from 40% to 15%) p<0.001). Condom use improved from a low baseline. Low rates of disclosure (55%) were reported by HIV positive clients. Overall, no changes in rates of life events were seen.

Conclusion: This study suggests that significant prevention gains can be recorded in clients receiving health centre based VCT services in Africa. Prevention issues should be considered when refining counseling and testing policies for expanding treatment programmes.