HIV counseling and testing in a rural Ugandan population

The only means currently available to stem the HIV/AIDS epidemic in sub-Saharan Africa is prevention. Decisions need to be made about where to spend scarce HIV/AIDS prevention resources, yet little information is available to evaluate the effectiveness of various prevention programs. In particular, the evaluation of HIV counseling and testing (C&T) has been hampered because of the self-selection of clients into these programs and the lack of information on those who choose not to participate in C&T. This dissertation evaluates a C&T program in rural Rakai district, Uganda using data from the Rakai sexually transmitted disease control for HIV prevention project. These data overcome previous difficulties with C&T evaluation because they are longitudinal, population-based and from a large sample. Moreover, they include information not only on those who chose to participate in the program, but also on an appropriate comparison group of individuals who chose not to participate. Three main questions were addressed in this dissertation: do those who are most at risk for HIV infection voluntarily choose to participate in C&T? does participation in C&T lead to subsequent behavior change? and how accurately do individuals perceive their risk of infection with the HIV virus? Although a relatively high proportion, about a third, chose to participate after each survey round, those who were at higher risk for HIV infection were less likely to participate in HIV C&T and that participation in HIV C&T appears to have little impact on subsequent behavior change over above the high rates of change to less risky behavior observed among those at high risk. Reported risk of exposure to infection with HIV was correlated with HIV risk characteristics, as well as actual HIV sero-status, suggesting that the HIV prevention messages of the national public health campaign are being absorbed. Throughout the analysis a gender differential was evident. Women are more likely than men to be infected with HIV, and are also less likely to voluntarily participate in the C&T program