Rosenberg, N.E., Westreich, D., Bärnighausen, T. AIDS (July 2013), E-publication ahead of print.
The authors conducted a cohort study from 2006 to 2011 among youth (ages 15-24) in high-prevalence KwaZulu-Natal, South Africa, using household surveillance and HIV and health surveys to compare HIV acquisition among youth who had and had not been exposed to HIV testing and counseling (HTC). Analysis suggested that HTC is effective in reducing HIV acquisition among uninfected youth; specifically, after HTC, there was a 41 percent reduction in the hazard of HIV acquisition over 4.5 years. While longitudinal multivariate analysis of risk factors showed that HTC was associated with lower incidence, in the short term, HTC-exposed youth were at greater risk. Of 3,959 youth eligible, 29 percent and 71 percent were initially HTC-exposed and-unexposed, respectively. HTC-exposed youth were more likely to be female, sexually experienced, and previously pregnant. Of those unexposed, 1,064 (38 percent) became HTC-exposed during follow-up. Initially, approximately one-third of respondents reported experiencing sexual debut and 43 percent of sexually active youth reported using a condom during their last sexual intercourse. Future research should examine the effect of HTC on sexual behaviors. Scaling up access to youth-friendly HTC, particularly as part of a combination prevention approach, and ensuring linkages to appropriate treatment and care could have substantial public health effects. The authors also concluded that these findings support South Africa’s recent action to provide HTC in secondary schools.