Voluntary counselling and testing (VCT) for HIV is promoted as a primary prevention
strategy to reduce the heterosexual transmission of HIV in sub-Saharan Africa. A
theoretical framework for the determinants of uptake of VCT and behavioural outcomes
following VCT was developed. Demographic and Health Survey (DHS) data collected
from 2003 to 2005 from ten countries were analysed to test the framework by comparing
nationally representative trends in uptake of testing. Data from a population-based open
cohort study in Manicaland, Zimbabwe was also used to test this framework by analysing
trends in sexual behaviour and behaviour change associated with having received VCT.
DHS data indicate that knowledge of serostatus varied widely between countries and
ranged from 2% among women in Guinea to 27% among women in Rwanda. Despite
these varied levels of testing, univariate analysis showed the profile of testers to be
remarkably similar across countries with respect to socio-demographic characteristics.
Adjusted analyses indicate that a secondary or higher level of education and an awareness
that treatment exists are key determinants of uptake of VCT. Uptake of VCT in the
Manicaland cohort is low, at 8.6% in the most recent survey. Against a background of
behavioural risk reduction in the general population, there was no evidence for additional
risk reduction associated with having received VCT in the Manicaland cohort.
This work provides a baseline for monitoring trends in testing and exploring changes in
the profile of those who get tested as provision of testing and treatment services increase.
Within the Manicaland study population, these results do not provide evidence that VCT
can promote behavioural risk reduction, in a context of background reductions in risk.
Uptake of VCT is expected to increase in this population as treatment becomes available.
It is important that VCT services are monitored and evaluated and the importance of risk
reduction is emphasised through good quality counselling. To succeed as a prevention
measure, VCT must attain a high coverage of the sexually active population and lead to
sustained risk reduction among both infected and uninfected individuals
