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AIDS Behav (2011) 15:18DOI 10.1007/s10461-010-9774-0
EDITORIAL REVIEW
Serosorting and the Evaluation of HIV Testing and Counseling for HIV Prevention in Generalized Epidemics
Georges Reniers Stphane Helleringer
Published online: 4 August 2010 Springer Science+Business Media, LLC 2010
Introduction
UNAIDS and the WHO recognize the importance of HIV Testing and Counseling (HTC) as a gateway to both treatment and prevention [1]. Many studies aimed at identifying behavioral changes following HTC have, however, registered only modest reductions in risk behaviors: changeif anyis most commonly reported by women, HIV positives, and in serodiscordant couples. This is also the gist of the review of early studies from predominantly Europe and North America [24], and a review of seven studies set in developing countries [5]. More recent studies from sub-Saharan Africa, summarized in Table 1, largely corroborate these conclusions. The most ambitious HTC impact evaluation studies target reductions in HIV incidence, but none have been detected so far [68]. In serodiscordant couples, however, HTC is associated with a reduction in HIV transmission [9].
Skeptics argue that the meager benets of HTC for HIV prevention will dilute further as efforts are mounted to increase HTC uptake. First, it is argued that the tested population will become less self-selective, and therefore less inclined to behavioral change [10]. Second, some observers anticipate that scaling up of HTC will affect the quality of counseling sessions, thereby reducing opportunities to promote behavioral change [11]. We argue that this pessimistic outlook on the role of HTC in fostering
behavioral change is premature. Existing studies may have under-estimated the preventative effects of HTC because they conceptualize behavioral change largely in terms of the ABC behaviors (abstinence, faithfulness and condom use), and because they almost exclusively measure the effects of HTC at the individual level (Table 1).
There is ample evidence that individuals in sub-Saharan African countries are not conned to the ABCs when developing strategies to lower their exposure to HIV: some divorce an infected or unfaithful spouse [1214], some discuss prevention measures with their primary partners [15, 16], and others deploysometimes elaboraterules to choose new partners they deem safe(r) [12, 13, 17]. One such strategy that has garnered less attention is serosorting; a practice whereby individuals seek partners of the same HIV serostatus and that was rst...