Research article Effect of home-based HIV counselling and testing on stigma and risky sexual behaviours: serial cross-sectional studies in Uganda

Background: A large, district-wide, home-based HIV counselling and testing (HBHCT) programme was implemented in Bushenyi district of Uganda from 2004 to 2007. This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability. We measured population-level changes in knowledge of HIV status, stigma and HIV-risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV. Methods: Serial cross-sectional surveys were carried out before and after the implementation of HBHCT programme in Bushenyi district of Uganda. A total of 1402 randomly selected adults (18 to 49 years) were interviewed in the baseline survey. After the implementation, a different set of randomly selected 1562 adults was interviewed using the same questionnaire. Data was collected on socio-demographic characteristics, sexual behaviour, whether respondents had ever tested for HIV and stigma and discrimination towards HIV/AIDS. Results: The proportion of people who had ever tested for HIV increased from 18.6 % to 62 % (pB0.001). Among people who had ever tested, the proportion of people who shared HIV test result with a sexual partner increased from 41 % to 57% (pB0.001). The proportion of persons who wanted infection status of a family member not to be revealed decreased from 68% to 57 % (pB0.001). Indicators of risk behaviour also improved; the proportion of people who exchanged money for sex reduce