To explore behaviour change, baseline risk behaviour, perception of risk, HIV disclosure and life events in health centre‐based voluntary counselling and testing (VCT) clients.
Design and setting
Single‐arm prospective cohort with before–after design at three (one urban and two rural) government health centres in Kenya; study duration 2 years, 1999–2001.
Consecutive eligible adult clients.
Main outcome measures
Numbers of sexual partners, partner type, condom use, reported symptoms of sexually transmitted infection, HIV disclosure and life events.
High rates of enrolment and follow‐up provided a demographically representative sample of 401 clients with mean time to follow‐up of 7.5 months. Baseline indicators showed that clients were at higher risk than the general population, but reported a poor perception of risk. Clients with multiple partners showed a significant reduction of sexual partners at follow‐up (16% to 6%; p<0.001), and numbers reporting symptoms of sexually transmitted infection decreased significantly also (from 40% to 15%; p<0.001). Condom use improved from a low baseline. Low rates of disclosure (55%) were reported by HIV‐positive clients. Overall, no changes in rates of life events were seen.
This study suggests that significant prevention gains can be recorded in clients receiving health centre‐based VCT services in Africa. Prevention issues should be considered when refining counselling and testing policies for expanding treatment programmes.