The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study

Rosenberg, Nora E.; Graybill, Lauren A.; Wesevich, Austin; McGrath, Nuala; Golin, Carol E.; Maman, Suzanne; Bhushan, Nivedita L.; Tsidya, Mercy; Chimndozi, Limbikani; Hoffman, Irving; Hosseinipour, Mina C.; Miller, William C.

doi:10.1097/qai.0000000000001398

Cited by 20 publications

(25 citation statements)

References 41 publications

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“…At the same time, FSWs in Uganda believe that the vast majority of their clients are living with HIV and thus may be unconcerned about infecting their clients. These reasons may explain why the results from our study among FSWs differ from the results of studies in general populations, which have mostly found that knowledge of HIV‐positive status is associated with a reduction in HIV risk‐related sexual behaviours .…”

Section: Discussioncontrasting

confidence: 99%

“…In urban Uganda, knowledge of HIV status was not associated with FSWs’ number of clients on an average working night, but knowledge of HIV‐negative status was significantly associated with an increase in FSWs’ consistent condom use with clients. This latter finding is different from most of the previous studies on knowledge of HIV status and sexual behaviour, which took place among members of the general population and found that knowledge of HIV‐negative status was not associated with HIV risk‐related sexual behaviours . It is particularly encouraging that FSWs in this setting who learn that they are HIV‐negative forgo the opportunity to make almost triple the amount of money for a sex act without a condom compared to a sex act with a condom – presumably to protect themselves from HIV acquisition.…”

Section: Discussioncontrasting

confidence: 87%

“…Many governments and international organizations have thus invested heavily in HIV testing , including clinic‐based testing , home‐based testing and HIV self‐testing , so that individuals can initiate treatment as prevention (TasP) or pre‐exposure prophylaxis (PrEP) to prevent HIV transmission or acquisition respectively. The effect of knowledge of HIV status on the sexual behaviours that increase the risk of HIV transmission, however, remains unclear despite numerous studies in diverse populations .…”

Section: Introductionmentioning

confidence: 99%

“…The majority of previous studies among members of the general population in high HIV prevalence settings found no association between knowledge of HIV‐negative status and individuals’ sexual behaviours and a negative association between knowledge of HIV‐positive status and individuals’ HIV risk‐related sexual behaviours . Knowledge of HIV status may have different effects on sexual behaviour among female sex workers (FSWs) in similar settings, because FSWs face strong economic incentives for many sexual partners and the provision of condomless sex .…”

Section: Introductionmentioning

confidence: 99%

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Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda

Ortblad

Musoke²,

Ngabirano

et al. 2019

J Intern AIDS Soc

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Introduction Female sex workers (FSWs) have strong economic incentives for sexual risk‐taking behaviour. We test whether knowledge of HIV status affects such behaviours among FSWs. Methods We used longitudinal data from a FSW cohort in urban Uganda, which was formed as part of an HIV self‐testing trial with four months of follow‐up. Participants reported perceived knowledge of HIV status, number of clients per average working night, and consistent condom use with clients at baseline, one month, and four months. We measured the association between knowledge of HIV status and FSWs’ sexual behaviours using linear panel regressions with individual fixed effects, controlling for study round and calendar time. Results Most of the 960 participants tested for HIV during the observation period (95%) and experienced a change in knowledge of HIV status (71%). Knowledge of HIV status did not affect participants’ number of clients but did affect their consistent condom use. After controlling for individual fixed effects, study round and calendar month, knowledge of HIV‐negative status was associated with a significant increase in consistent condom use by 9.5 percentage points (95% CI 5.2 to 13.5, p < 0.001), while knowledge of HIV‐positive status was not associated with a significant change in consistent condom use (2.5 percentage points, 95% CI −8.0 to 3.1, p = 0.38). Conclusions In urban Uganda, FSWs engaged in safer sex with clients when they perceived that they themselves were not living with HIV. Even in communities with very high HIV prevalence, the majority of the population will test HIV‐negative. Our results thus imply that expansion of HIV testing programmes may serve as a behavioural HIV prevention measure among FSWs.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda

Ortblad

Musoke²,

Ngabirano

et al. 2019

J Intern AIDS Soc

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“…increases uptake of HIV prevention and care services and identification of HIV sero-discordant couples [6][7][8]. The 'Primary HIV Prevention among Pregnant and Lactating Ugandan Women' (PRIMAL) randomized controlled trial (RCT) assessed the effect of the enhanced counseling component effects of an extended repeat HIV testing and enhanced counseling (ERHTEC) intervention on 410 HIVnegative pregnant and lactating women and 205 of their male partners compared to an equal number of controls on risk reduction behavior and the risk of STI and HIV acquisition by these mothers during late pregnancy and throughout the breastfeeding period [9].…”

Section: Studies In East and Southern Africa Have Shown That Couple Hmentioning

confidence: 99%

“[ Repeat ] testing and counseling is one of the key [ services ] that the government should continue providing”: Participants’ Perceptions on Extended Repeat HIV Testing and Enhanced Counseling (ERHTEC) for Primary HIV Prevention in Pregnant and Lactating Ugandan Women

Bannink

Namukwaya

Amoone

et al. 2019

Preprint

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Background The ‘Primary HIV Prevention among Pregnant and Lactating Ugandan Women’ (PRIMAL) randomized controlled trail aimed to assess an enhanced counseling strategy linked to extended repeat HIV testing among HIV-negative pregnant and lactating women aged 18-49 years and 410 of their male partners to address the first pillar of the WHO Global Strategy for the Prevention of Mother-to-Child HIV transmission. Methods: PRIMAL Study participants were enrolled from two antenatal care clinics and randomized 1:1 to an intervention or control arm. Both arms received repeat STI and HIV testing at enrollment, labor and delivery, and at 3, 6, 12, 18 and 24 months postpartum. The intervention consisted of enhanced quarterly counseling on HIV risk reduction, couple communication, family planning and nutrition delivered by study counselors. Control participants received repeat standard post-test counseling. Eighteen focus group discussions and 44 key informant interviews were held to evaluate study participants’ and service providers’ perceptions and acceptance of the intervention and understand the effects of the intervention on risk reduction, couple communication, and emotional support from partners. Results: At baseline participants mentioned multiple sexual partners and lack of condom use as the main risks for pregnant and lactating women to acquire HIV. The main reasons for having multiple sexual partners were 1) the cultural practice not to have sex in the late pre-natal and early post-natal period; 2) increased sexual desire during pregnancy; 3) alcohol abuse; 4) poverty; and 5) conflict in couples. Consistent condom use at baseline was limited due to lack of knowledge and low acceptance of condom use in couples. The majority of intervention participants enrolled felt enhanced counselling improved understanding, faithfulness, mutual support and appreciation within their couple. Another benefit mentioned by participants was improvement of couple communication and negotiation, as well as daily decision-making around sexual needs, family planning and condom use. Participants stressed the importance of providing counselling services to all couples. Conclusions: This study shows that repeat postpartum testing and enhanced individual and couple counselling increased condom use, supported risk reduction, and improved support, communication and decision-making about sexual and reproductive health for pregnant and lactating women.

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Sexual behaviour change following HIV testing services: a systematic review and meta‐analysis

et al. 2020

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Introduction Learning one’s HIV status through HIV testing services (HTS) is an essential step toward accessing treatment and linking to preventive services for those at high HIV risk. HTS may impact subsequent sexual behaviour, but the degree to which this varies by population or is true in the setting of contemporary HIV prevention activities is largely unknown. As part of the 2019 World Health Organization Consolidated Guidelines on HTS, we undertook a systematic review and meta‐analysis to determine the effect of HTS on sexual behaviour. Methods We searched nine electronic databases for studies published between July 2010 and December 2019. We included studies that reported on at least one outcome (condom use [defined as the frequency of condom use or condom‐protected sex], number of sex partners, HIV incidence, STI incidence/prevalence). We included studies that prospectively assessed outcomes and that fit into one of three categories: (1) those evaluating more versus less‐intensive HTS, (2) those of populations receiving HTS versus not and (3) those evaluating outcomes after versus before HTS. We conducted meta‐analyses using random‐effects models. Results and discussion Of 29 980 studies screened, 76 studies were included. Thirty‐eight studies were randomized controlled trials, 36 were cohort studies, one was quasi‐experimental and one was a serial cross‐sectional study. There was no significant difference in condom use among individuals receiving more‐intensive HTS compared to less‐intensive HTS (relative risk [RR]=1.03; 95% CI: 0.99 to 1.07). Condom use was significantly higher after receiving HTS compared to before HTS for individuals newly diagnosed with HIV (RR = 1.65; 95% CI: 1.36 to 1.99) and marginally significantly higher for individuals receiving an HIV‐negative diagnosis (RR = 1.63; 95% CI: 1.01 to 2.62). Individuals receiving more‐intensive HTS reported fewer sex partners at follow‐up than those receiving less‐intensive HTS, but the finding was not statistically significant (mean difference = −0.28; 95% CI: −3.66, 3.10). Conclusions Our findings highlight the importance of using limited resources towards HTS strategies that focus on early HIV diagnosis, treatment and prevention services rather than resources dedicated to supplementing or enhancing HTS with additional counselling or other interventions.

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The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study

Cited by 20 publications

References 41 publications

Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda

Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda

“[ Repeat ] testing and counseling is one of the key [ services ] that the government should continue providing”: Participants’ Perceptions on Extended Repeat HIV Testing and Enhanced Counseling (ERHTEC) for Primary HIV Prevention in Pregnant and Lactating Ugandan Women

Sexual behaviour change following HIV testing services: a systematic review and meta‐analysis

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