Updated 23 October 2013

Brief STD counselling ineffective

Briefly counselling people who take a rapid HIV test on how to reduce their risk for sexually transmitted diseases is not effective.


Contrary to what experts have believed, briefly counselling people who take a rapid HIV test on how to reduce their risk for sexually transmitted diseases (STDs) is not effective, a new study shows.

Counselling for these at-risk patients did not reduce the incidence of STDs up to six months after patients were tested for HIV, the study found. A more focused approach to providing information at the time of testing may be needed, the authors said, since counselling requires valuable resources of time, money and personnel.

"Overall, these study findings lend support for reconsidering the role of counselling as an essential adjunct to HIV testing," study author Lisa Metsch, at Columbia University's Mailman School of Public Health, and colleagues wrote in the Journal of the American Medical Association.

"This inference is further buttressed by the additional costs associated with counselling at the time of testing: Without evidence of effectiveness, counselling cannot be considered an efficient use of resources," they added.

In the United States alone, about 50 000 new HIV infections occur every year, according to a journal news release. The US Preventive Services Task Force recently recommended that all people aged between 15 and 65 be screened for HIV (which causes AIDS).

Risk-reduction counselling

The researchers randomly assigned about 5 000 patients treated at nine STI clinics in the United States to receive either brief patient-centred HIV risk-reduction counselling along with a rapid HIV test, or the rapid HIV test with information only and no risk-reduction counselling.

Patients who were counselled received advice on their specific high-risk behaviors and concrete steps they could take to reduce their risk for STDs. The researchers assessed STDs among the patients when the study began and again six months after they had their HIV test.

Both men and women were tested for gonorrhea, chlamydia, syphilis, genital herpes and HIV, along with Trichomonas testing for women.

During the study, the STD incidence was 12.3% in the counselling group and 11.1% in the information-only group. The researchers noted that their findings were consistent at all nine STI clinics and after taking into account the patients' age, sex, race and ethnicity.

However, counselling is vital for patients who are indeed found to have HIV, the researchers emphasised.

"Post-test counselling for persons testing HIV-positive remains essential, both for addressing psychological needs and for providing and ensuring follow-through with medical care and support," they wrote. "A more focused approach to providing information at the time of testing may allow clinics to use resources more efficiently to conduct universal testing, potentially detecting more HIV cases earlier and linking and engaging HIV-infected people in care."

More information

The U.S. Department of Health and Human Services has more about sexually transmitted diseases.

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Dr Sindisiwe van Zyl qualified at the University of Pretoria before working for an HIV/AIDS NPO in Soweto for many years. She was named one of the Mail & Guardian's Top 200 Young South Africans in 2012.

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