Risk-reduction counseling with HIV testing may not decrease rates of sexually transmitted infections

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1. Risk-reduction counseling at the time of rapid HIV (human immunodeficiency virus) testing was not associated with lower rates of incident sexually transmitted infections when compared to HIV testing with verbal information alone. 

2. The additional costs associated with providing risk-reduction counseling as opposed to verbal information at the time of rapid HIV testing may not be justified based on the results of this study.

Evidence Rating Level: 2 (Good) 

Study Rundown: Rapid human immunodeficiency virus (HIV) testing is an important public health effort and can be done quite efficiently using widely available and affordable tests.  Many HIV testing programs include an aspect of risk-reduction counseling at the time of testing.  This requires a great deal of time and resources; however, there is mixed evidence regarding the effectiveness of risk-reduction counseling.  This study followed 5012 individuals from nine STI (sexually transmitted infection) clinics around the United States for six months to assess STI incidence.  The participants were randomized to have either an HIV test with risk-reduction counseling or an HIV test with verbal information only. At 6 months, there was no overall difference in STI incidence between the two groups.  However, in subgroup analysis, men having sex with men in the risk-reduction group had a higher incidence of STIs than those in the information only group.  Participants in the counseling group reported lower rates of unprotected sexual intercourse, lower number of total partners, and no difference in the number of unprotected sexual partners.  A strength of this study is the fact that participants from nine sites all over the US were included.  A significant weakness of this study includes the relatively short follow-up period and limited generalizability to international settings.  Ultimately, research including participants from more sites followed over a longer period of time will be necessary to determine the importance of risk-reduction counseling with rapid HIV testing.

Click to read the study published today in JAMA

Click to read an accompanying editorial published today in JAMA

Relevant Reading: Behavioral counseling to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force

In-Depth [randomized study]: This study randomized 5012 individuals to undergo rapid HIV testing with patient-centered risk-reduction counseling or rapid HIV testing with information only.  After six months, there was no difference in the overall STI incidence between the two groups (adjusted risk ratio 1.12, 95% CI 0.94-1.33).  There were, however, more incident STIs in the men having sex with men subgroup who received risk-reduction counseling over the study period (18.7% vs. 12.5%, adjusted risk ratio 1.41, 98.3% CI 1.05-1.90).  There was no difference in incident STIs between the risk-reduction and information only groups in women (adjusted risk ratio 1.07, 98.3% CI 0.79-1.43) or men having sex with women (adjusted risk ratio 0.81, 98.3% CI 0.50-1.31).  Participants randomized to counseling did report fewer unprotected sexual encounters with non-primary partners (incidence rate ratio 0.66, 95% CI 0.55-0.79) and fewer partners (incidence rate ratio 0.81, 95% CI 0.75-0.87), but the same number of unprotected partners.

By Jeffrey Cohen and Brittany Hasty

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