Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985-1997

Objectives. This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior. Methods. The meta-analysis included 27 published studies that provided sexu al behavior outcome data, assessed behavior before and after counseling aci d testing, and provided details sufficient for the calculation of effect si zes. The studies involved 19 597 participants. Results. After counseling and testing,HIV-positive participants and HIV-ser odiscordant couples reduced unprotected intercourse and increased condom us e more than HIV-negative and untested participants. HIV-negative participan ts did not modify their behavior more than untested participants. Participa nts' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up: explained t he variance in results. Conclusions. HIV counseling and testing appears to provide an effective mea ns of secondary prevention for HIV-positive individuals but as conducted in the reviewed studies, is not an effective primary prevention strategy for uninfected participants. Theory-driven research with attention given to the context of testing is needed to further explicate the determinants of beha vior change resulting from HIV counseling and testing, and the effectivenes s of specific counseling approaches.