title: HIV testing and counseling leads to immediate consistent condom use among South African stable HIV-discordant couples.
abstract: OBJECTIVE
  Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples.
  
  
  METHODS
  Partners in Prevention HSV/HIV Transmission Study was a randomized trial conducted from 2004 to 2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1-coinfected persons to HIV-uninfected sex partners. This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants. The exposure was timing of first HIV testing and counseling: 0-7, 8-14, 15-30, or >30 days before baseline. In each exposure group, predicted probabilities of unprotected sex in the last month were calculated at baseline, month 1, and month 12 using generalized estimating equations with a logit link and exchangeable correlation matrix.
  
  
  RESULTS
  At baseline, participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month: 0-7 days, 0.71; 8-14 days, 0.52; 15-30 days, 0.49; >30 days, 0.26. At month 1, once all participants had been aware of being in HIV-discordant relationships for ≥1 month, predicted probabilities declined: 0-7 days, 0.08; 8-14 days, 0.08; 15-30 days, 0.15; >30 days, 0.14. Lower predicted probabilities were sustained through month 12: 0-7 days, 0.08; 8-14 days, 0.11; 15-30 days, 0.05; >30 days, 0.19.
  
  
  CONCLUSIONS
  Unprotected sex declined after HIV-positive diagnosis and declined further after awareness of HIV discordance. Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA. nora_rosenberg@unc.edu
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Pettifor
authors.forename: Guy
authors.initials: G
authors.lastname: De Bruyn
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
authors.forename: Mercy
authors.initials: M
authors.lastname: Kamupira
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D037001:Directive Counseling; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016017:Odds Ratio; D040242:Risk Reduction Behavior; D057566:Self Report; D012747:Sexual Partners; D013019:South Africa; D013997:Time Factors; D047568:Unsafe Sex; D055815:Young Adult