Sherr Lorraine, Lopman Ben, Kakowa Memory, Dube Sabada, Chawira Godwin, Nyamukapa Constance, Oberzaucher Nicole, Cremin Ide, Gregson Simon
Royal Free Hospital, University College London, UK.
AIDS. 2007 Apr 23;21(7):851-60. doi: 10.1097/QAD.0b013e32805e8711.
To examine the determinants of uptake of voluntary counselling and testing (VCT) services, to assess changes in sexual risk behaviour following VCT, and to compare HIV incidence amongst testers and non-testers.
Prospective population-based cohort study of adult men and women in the Manicaland province of eastern Zimbabwe. Demographic, socioeconomic, sexual behaviour and VCT utilization data were collected at baseline (1998-2000) and follow-up (3 years later). HIV status was determined by HIV-1 antibody detection. In addition to services provided by the government and non-governmental organizations, a mobile VCT clinic was available at study sites.
Lifetime uptake of VCT increased from under 6% to 11% at follow-up. Age, increasing education and knowledge of HIV were associated with VCT uptake. Women who took a test were more likely to be HIV positive and to have greater HIV knowledge and fewer total lifetime partners. After controlling for demographic characteristics, sexual behaviour was not independently associated with VCT uptake. Women who tested positive reported increased consistent condom use in their regular partnerships. However, individuals who tested negative were more likely to adopt more risky behaviours in terms of numbers of partnerships in the last month, the last year and in concurrent partnerships. HIV incidence during follow-up did not differ between testers and non-testers.
Motivation for VCT uptake was driven by knowledge and education rather than sexual risk. Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT. It should be minimized with appropriate pre- and post-test counselling.
研究自愿咨询检测（VCT）服务接受情况的决定因素，评估VCT后性风险行为的变化，并比较检测者与未检测者之间的艾滋病毒发病率。
对津巴布韦东部马尼卡兰省的成年男性和女性进行基于人群的前瞻性队列研究。在基线期（1998 - 2000年）和随访期（3年后）收集人口统计学、社会经济、性行为和VCT使用数据。通过检测HIV - 1抗体确定艾滋病毒感染状况。除了政府和非政府组织提供的服务外，研究地点还设有流动VCT诊所。
随访时VCT的终生接受率从低于6%升至11%。年龄、教育程度提高以及对艾滋病毒的了解与VCT接受情况相关。接受检测的女性更有可能艾滋病毒呈阳性，对艾滋病毒的了解更多，终生性伴侣总数更少。在控制人口统计学特征后，性行为与VCT接受情况无独立关联。检测呈阳性的女性报告在其固定性伴侣关系中坚持使用避孕套的情况有所增加。然而，检测呈阴性的个体在过去一个月、过去一年以及同时存在的性伴侣关系数量方面更有可能采取更具风险的行为。随访期间，检测者与未检测者之间的艾滋病毒发病率无差异。
VCT接受的动机是由知识和教育驱动的，而非性风险。检测结果为阴性后性风险增加可能是VCT一个严重的意外后果。应通过适当的检测前和检测后咨询将其降至最低。
