title: How do HIV-negative individuals in sub-Saharan Africa change their sexual risk behaviour upon learning their serostatus? A systematic review.
abstract: OBJECTIVE
  To determine whether, and how, sexual behaviour of HIV-negative individuals in sub-Saharan Africa (SSA) changes upon learning their serostatus.
  
  
  METHODS
  We systematically reviewed the published literature using EMBASE and Medline to search for publications between 2004 and 2014. We included studies that quantified behaviour change (condom use, number of sexual partners or sex acts) following an HIV test in HIV-negative adults in SSA, and extracted relevant data including study characteristics and measurement type.
  
  
  RESULTS
  From 2185 unique citations, n=14 studies representing 22 390 participants met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. The proportion of participants reporting consistent condom use (n=6) post-testing ranged from 7.6% greater, to 10.6% fewer, while 'no condom use' (n=5) ranged from 40.0% less, to 0.7% more. Condom use in serodiscordant couples increased (n=3). Five studies measured the proportion reporting abstinence, finding an increase of 10.9% to a decrease of 5.3% post-testing. The post-testing change in the mean number of sex acts (n=3) ranged from a relative decrease of 15.7% to a relative increase of 9.4%. Two studies reported relative decreases in the mean number of sexual partners of 35.2% and 14.0%. Three studies examining serodiscordant primary relationships specifically all showed increases in extrarelational sex.
  
  
  CONCLUSIONS
  With the exception of serodiscordant couples, there is variable evidence that awareness of one's serostatus leads to substantial changes in risk behaviour among HIV-negative individuals. Further research is needed to estimate the behavioural impact of learning one's serostatus in SSA.
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Ramachandran
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.|Division of Infectious Diseases, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Sharmistha
authors.identifier: http://orcid.org/0000-0001-8492-5470
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Condie
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-6754-3945
authors.initials: M
authors.lastname: Pickles
mesh_terms: D000223:Adaptation, Psychological; D017954:Africa South of the Sahara; D037001:Directive Counseling; D018023:HIV Seronegativity; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology*
keywords: BEHAVIOURAL INTERVENTIONS; COUNSELLING; HIV TESTING; SEXUAL BEHAVIOUR; SYSTEMATIC REVIEWS