Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997.
OBJECTIVE
This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior.


METHODS
The meta-analysis included 27 published studies that provided sexual behavior outcome data, assessed behavior before and after counseling and testing, and provided details sufficient for the calculation of effect sizes. The studies involved 19,597 participants.


RESULTS
After counseling and testing, HIV-positive participants and HIV-serodiscordant couples reduced unprotected intercourse and increased condom use more than HIV-negative and untested participants. HIV-negative participants did not modify their behavior more than untested participants. Participants' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up, explained the variance in results.


CONCLUSIONS
HIV counseling and testing appears to provide an effective means of secondary prevention for HIV-positive individuals but, as conducted in the reviewed studies, is not an effective primary prevention strategy for uninfected participants. Theory-driven research with attention given to the context of testing is needed to further explicate the determinants of behavior change resulting from HIV counseling and testing, and the effectiveness of specific counseling approaches.
Weinhardt
L S
LS
Department of Psychology, Syracuse University, NY 13244-2340, USA.
Carey
M P
MP
Johnson
B T
BT
Bickham
N L
NL
D015492:AIDS Serodiagnosis; D000328:Adult; D000367:Age Factors; D017280:Condoms; D003376:Counseling / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000523:psychology; D015528:HIV Seroprevalence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011322:Primary Prevention / Q000458:organization & administration; D015397:Program Evaluation; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications; D016896:Treatment Outcome