Reducing HIV-1 in Kenya and Tanzania

Abstract

Authors' reply Sir—The results from the Voluntary HIV-1 Counseling and Testing Efficacy Study Group are very convincing.1The Voluntary HIV-1 Counselling and Testing Efficacy Study GroupEfficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial.Lancet. 2000; 356: 103-112Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar As a young physician and consultant to the Red Cross Society in the 1980s, I participated in the development of the national AIDS control programme in Uganda. The number of AIDS cases in the country increased continually, whereas control activities were still in their infancy.2Goodgame RW AIDS in Uganda: clinical and social features.N Engl F Med. 1990; 323: 383-389Crossref PubMed Scopus (92) Google Scholar I was shocked by the obvious discrepancy between a high public awareness of the AIDS epidemic in Uganda resulting from a well designed IEC programme, and the proportion of AIDS cases in almost every family, in contrast to the virtual absence of VCT services. Since I was accustomed to such services being widely available in Europe and convinced about their effect on promoting behaviour change, I and my colleagues started a VCT centre in Uganda. Although the idea was initially met with some reservations about its feasibility and sustainability, we successfully set up the service in a busy street of central Kampala in early 1990. Our first experiences showed the demand for and the feasibility of VCT in Uganda and that such an intervention effectively achieves behaviour change.3Müller O Barugahare L Schwartländer B et al.HIV prevalence, attitudes and behaviour in clients of a confidential HIV testing and counselling centre in Uganda.AIDS. 1992; 6: 869-874Crossref PubMed Scopus (55) Google Scholar The centre finally developed into a country-wide network which provided its services to about 500 000 Ugandans. The availability of VCT services has probably substantially contributed to the overall success of the Ugandan AIDS control programme.4Asiimwe-Okiror G Opio AA Musinguzi J Madraa E Tembo G Carael M Change in sexual behaviour and decline in HIV infection among young pregnant women in Urban Uganda.AIDS. 1997; 11: 1757-1763Crossref PubMed Scopus (198) Google Scholar Overwhelming evidence shows benefits of providing VCT services in less-developed countries at all stages of the epidemic,1The Voluntary HIV-1 Counselling and Testing Efficacy Study GroupEfficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial.Lancet. 2000; 356: 103-112Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar, 5Müller O Phanuphak P Voluntary HIV counselling and testing in developingcountries.Lancet. 1993; 342: 117Abstract PubMed Scopus (6) Google Scholar and their contribution to HIV prevention.