HIV spread 'could be checked'

Aids has reaped a terrible toll in Africa and other developing countries

A programme of voluntary counselling and testing (VCT) for HIV could have a significant impact in reducing the spread of the virus in developing countries, say researchers.

VCT has been given a low priority as a possible strategy for combating HIV in developing countries because it is difficult to administer, and it was thought that many patients would not want to know their results or be motivated to change their behaviour.

Our results demonstrate that something can be done now in developing countries

Dr Thomas Coates, UCSF AIDS Research Institute

However, a study of the impact of VCT in Kenya, Tanzania and Trinidad found that it led both to a reduction in risky sexual behaviour and in the spread of sexually transmitted diseases.

After receiving VCT, the proportion of men who went on to have unprotected sex with somebody who was not their regular partner fell by 35%. In a control group which simply received basic health information, the proportion fell by just 13%.

For women the figures were 39% compared to 17%.

The researchers also found that HIV positive men were more likely than uninfected men to reduce unprotected intercourse.

Cost-effectiveness

A second report on the cost-effectiveness of such a strategy concluded that it was good value for money.

VCT was estimated to have averted 1,104 HIV-infections in Kenya, and 895 infections in Tanzania in the subsequent year.

The researchers calculated that the cost of each averted HIV infection was US$249 in Kenya, and US$346 in Tanzania.

They also calculated that in Kenya it cost US$12.77 for each extra year of disability-free life that the programme generated.

Dr Thomas Coates, executive director of the University of California San Francisco Aids Research Institute, led the study into the impact of VCT.

He said: "Our results demonstrate that something can be done now in developing countries, even though we don't have a vaccine and treatments are not affordable."

Dr Michael Sweat, from The Johns Hopkins University School of Hygiene and Public Health, led the team which undertook the cost analysis.

He said: "Our cost-effectiveness analysis makes a compelling case to affected countries and donors that limited resources need not be a reason for inaction."