Does HIV VCT reduce risk behaviors? An observational study in Guatemala City

Objective: We examined the impact of HIV voluntary counseling and testing on self-reported behavioral risks three months after HIV testing. Design: Cohort study comparing self-reported risk behaviors prior to and three months after HIV testing. Setting: Clínica Familiar Luis Ángel García, an HIV specialty clinic located in a Guatemalan National Hospital. Subjects, Participants: 144 people undergoing HIV testing were enrolled. 44 were HIV positive. 41 HIV positive and 49 HIV negative subjects returned for follow-up interviews. Intervention: All subjects were tested and received voluntary counseling regarding HIV infection, transmission, prevention, and interpretation of HIV test results. Main Outcome Measure: The primary study outcome measure was changed in self-reported risk behaviors three months after voluntary counseling and testing. Results: Men were more likely than women to report a history of sexually transmitted diseases, more than 2 sexual partners, using alcohol with sex, and receiving money for sex; they were less likely to have a regular partner. 26% of men reported non-heterosexual orientation; no woman did. Alcohol was the primary drug of abuse in both men and women. At three month follow-up HIV positive subjects showed decrease in the average number of sexual partners, use of alcohol with sex, and episodes of unprotected sex. Conclusions: Voluntary counseling and testing resulted in changes in some self-reported risk behaviors, but only among HIV positive subjects. On nearly all measures men reported riskier behavior than women. Alcohol is the most commonly used drug in this population and is often used with sex.