Can new HIV preventions be prevented in Myanmar? Not by increasing testing. HIV testing has never been shown to decrease HIV incidence. Voluntary counselling and testing cannot be included in a list of effective HIV prevention activities as testing does not prevent HIV acquisition and has little impact on HIV transmission.

There is limited evidence of behaviour change as an outcome of voluntary counselling and testing. Last year a revised Cochrane review was published.

Fonner VA, Denison J, Kennedy CE, O’Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV related risk behavior in developing countries. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD001224. DOI:10.1002/14651858.CD001224.pub4

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001224.pub4/abstract;jsessionid=ADA3174664F4341C26A333DC90964CFB.d02t03

The review found that voluntary counselling and testing has only a small effect on subsequent sexual behaviour. People who had undergone voluntary counselling and testing were more likely to report reducing their number of sexual partners than those who did not undergo it. But the results were only significant for those who tested positive.

Voluntary counselling and testing was not statistically effective in increasing condom use among all people who had undergone it. Only those who tested positive were significantly more likely to report condom use than HIV positive trial subjects who did not undergo voluntary counselling and testing.

In brief, those who test positive are more likely to change their behaviour while those who test negative are NOT more likely to change their behaviour. Since the vast majority of people who undergo voluntary counselling and testing are seronegative, testing can have little impact on sexual behaviour in a community. It will have almost no impact in low prevalence epidemics. It has not been proven to decrease transmission in the many parts of the world where unsafe injecting behaviour underlies the epidemic.

HIV counselling and testing is still the gateway to care, support, and treatment and voluntary counselling and testing should be continued for only this reason.

But the words prevention and testing should not be used together and testing should be removed from prevention programme. The Global Fund should stop funding testing as a prevention intervention. WHO should remove testing from its list of prevention activities and UNAIDS needs to begin to talk about other prevention methods without referring to testing. Americans who want to promote ‘combination prevention’ should be careful to exclude testing from their list of prevention activities.  PEPFAR should remove testing from the ‘prevention side’ and put it into the ‘treatment side’ where it belongs. This will decrease the already-paltry PEPFAR investment in prevention.

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Jamie