title: Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda.
abstract: OBJECTIVE
  To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda.
  
  
  METHODS
  In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively.
  
  
  RESULTS
  Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85-0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90-0.99) or higher (adj. RR = 0.91; 95% CI, 0.87-0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68-0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90-0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82-0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08-1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04-1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT.
  
  
  CONCLUSIONS
  In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Joseph K B
authors.initials: JK
authors.lastname: Matovu
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Fredrick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003376:Counseling / Q000379:methods*; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011446:Prospective Studies; D012309:Risk-Taking; D012423:Rural Health; D012725:Sexual Behavior / Q000523:psychology*; D014454:Uganda / Q000453:epidemiology