***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : To examine the determinants of uptake of voluntary counselling and testing ( VCT ) services , to assess changes in sexual risk behaviour following VCT , and to compare HIV incidence amongst testers and non-testers . Methods : Prospect i ve population -based cohort study of adult men and women in the Manical and province of eastern Zimbabwe . Demographic , socioeconomic , sexual behaviour and VCT utilization data were collected at baseline ( 1998–2000 ) and follow-up ( 3 years later ) . HIV status was determined by HIV-1 antibody detection . In addition to services provided by the government and non-governmental organizations , a mobile VCT clinic was available at study sites . Results : Lifetime uptake of VCT  increased from under 6 % to 11 % at follow-up . Age , increasing education and knowledge of HIV were associated with VCT uptake . Women who took a test were more likely to be HIV positive and to have greater HIV knowledge and fewer total lifetime partners . After controlling for demographic characteristics , sexual behaviour was not independently associated with VCT uptake . Women who tested positive reported increased consistent condom use in their regular partnerships . However , individuals who tested negative were more likely to adopt more risky behaviours in terms of numbers of partnerships in the last month , the last year and in concurrent partnerships . HIV incidence during follow-up did not differ between testers and non-testers . Conclusion : Motivation for VCT uptake was driven by knowledge and education rather than sexual risk . Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT . It should be minimized with appropriate pre- and post-test counselling Abstract Objective : To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women . Design : R and omised controlled trial involving four combinations of written and verbal communication , followed by the direct offer of a test . The control group received no information and no direct offer of a test , although testing was available on request . Setting : Hospital antenatal clinic covering most of the population of the city of Edinburgh . Subjects : 3024 pregnant women booking at the clinic over a 10 month period . Main outcome measures : Uptake of HIV testing and women 's knowledge , satisfaction , and anxiety . Results : Uptake rates were 6 % for those in the control group and 35 % for those directly offered the test . Neither the style of leaflet nor the length of discussion had an effect on uptake . Significant independent predictors of uptake were a direct test offer ; the midwife seen ; and being unmarried , previously tested , and younger age . Knowledge of the specific benefits of testing increased with the amount of information given , but neither satisfaction nor anxiety was affected by the type of offer . Conclusions : The universal offer of HIV testing is not intrusive and is acceptable to pregnant women . A policy of offering the HIV test to all women result ed in higher uptake and did not increase anxiety or dissatisfaction . Uptake depends more on the midwife than the method of offering the test . Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing . Key messages HIV testing in pregnancy is beneficial , but uptake rates are not high Offering the test to women attending antenatal clinics increases uptake without increasing anxiety or dissatisfaction The extent of information given is not important in terms of whether women take the test and whether they find the procedure acceptable Uptake depends more on the midwife than the method of offering the test Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to OBJECTIVE To determine whether human immunodeficiency virus ( HIV ) counseling and testing has an effect on reducing subsequent risk behaviors in those tested , to evaluate stability in condom use over time , and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases ( STDs ) . DESIGN Cohort study with 2-year follow-up . SETTING An urban adolescent-medicine clinic . PARTICIPANTS A r and om sample of 149 patients ( 118 female and 31 male adolescents ) with a mean ( + /- SD ) age of 16.4 + /- 1.51 years were selected from a cohort of 500 patients at high risk for HIV infection . The patients had received a risk behavior question naire during pretest counseling for HIV testing . They were divided into 3 groups , identified by the letter F , S , or R , based on their self-report of frequency of condom use at enrollment : 24 % used condoms frequently/always ( F ) ; 40 % , sometimes ( S ) ; and 36 % , rarely/never ( R ) . One hundred twenty-six patients ( 85 % ) made return visits . INTERVENTION HIV counseling and testing . MAIN OUTCOME MEASURES Medical record documentation of STDs before and after HIV testing , and self-reported condom use frequency . RESULTS Before HIV testing , all 3 condom use groups had a similar frequency of STD visits per month . The number of STD visits per month did not decrease significantly in the posttest period for either the total group or each of the 3 subgroups . Also , most patients ( F , 67 % ; S , 44 % ; R , 53 % ) in each of the 3 subgroups had shifted unfavorably to rarely/never ( R ) condom use within the month before their follow-up visit . Only 24 % ( 8 patients ) of those in the initial frequently/always ( F ) group reported continued frequent condom use . CONCLUSIONS As has been found in adult studies , single-dose interventions such as HIV counseling and testing did not seem to reduce HIV risk behaviors in our sample of high-risk adolescent patients . None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling . Also , our adolescent patients reported widely varying condom use frequency over time , yet the incidence of STDs did not correlate with self-reported condom use Objective : To test the efficacy of brief , safer-sex counseling by medical providers of HIV-positive patients during medical visits . Setting : Six HIV clinics in California . Design : Clinics were r and omized to intervention arms evaluated with cohorts of r and omly selected patients measured before and after the intervention . Participants : Five-hundred and eighty-five HIV-positive persons , sexually active prior to enrollment . Interventions : Prevention counseling from medical providers supplemented with written information . Two clinics used a gain-framed approach ( positive consequences of safer-sex ) , two used a loss-frame approach ( negative consequences of unsafe sex ) , and two were attention-control clinics ( medication adherence ) . Interventions were given to all patients who attended the clinics . Outcome measure : Self-reported unprotected anal or vaginal intercourse ( UAV ) . Results : Among participants who had two or more sex partners at baseline , UAV was reduced 38 % ( P < 0.001 ) among those who received the loss-frame intervention . UAV at follow-up was significantly lower in the loss-frame arm [ odds ratio ( OR ) , 0.42 ; 95 % confidence interval ( CI ) , 0.19–0.91 ; P = 0.03 ] compared with the control arm . Using generalized estimating equations ( GEE ) to adjust for clustering did not change the conclusions ( OR , 0.34 ; 95 % CI , 0.24–0.49 ; P = 0.0001 ) . Similar results were obtained in participants with casual partners at baseline . No effects were seen in participants with only one partner or only a main partner at baseline . No significant changes were seen in the gain-frame arm . Conclusions : Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles OBJECTIVE --To determine whether HIV testing and counselling increased condom use and decreased heterosexual transmission of HIV in discordant couples . DESIGN -- Prospect i ve study . SETTING --Kigali , the capital of Rw and a. SUBJECTS -- Cohabiting couples with discordant HIV serology results . MAIN OUTCOME MEASURES --Condom use in the couple and HIV seroconversion in the negative partners . RESULTS --60 HIV discordant couples were identified , of whom 53 were followed for an average of 2.2 years . The proportion of discordant couples using condoms increased from 4 % to 57 % after one year of follow up . During follow up two of the 23 HIV negative men and six of the 30 HIV negative women seroconverted ( seroconversion rates of 4 and 9 per 100 person years ) . The rate among women was less than half that estimated for similar women in discordant couples whose partners had not been serotested . Condom use was less common among those who seroconverted ( 100 % v 5 % , p = 0.01 in men ; 67 % v 25 % , p = 0.14 in women ) . CONCLUSIONS --Roughly one in seven cohabiting couples in Kigali have discordant HIV serological results . Confidential HIV serotesting with counselling caused a large increase in condom use and was associated with a lower rate of new HIV infections .  HIV testing is a promising intervention for preventing the spread of HIV in African cities OBJECTIVES : The purpose s of this study were to ( a ) assess the efficacy of a culturally tailored behavioral intervention to increase use and acceptability of sexual barrier products among HIV+ and HIV- Zambian women , ( b ) compare group versus individual interventions to increase barrier use and acceptability , and ( c ) vali date the role of cultural factors as facilitators or impediments to sexual risk reduction . METHODS : A sample of 150 HIV+ and HIV- Zambian women was recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Centre , r and omized into one of three conditions , and assessed at baseline and 6 months . Group and individual intervention participants attended a 3-session intervention plus pre- and post-HIV test counseling ; control participants received pre- and post-test counseling only . RESULTS : Group intervention participants increased use of sexual barriers and had higher levels of acceptability than did individual intervention participants . HIV- group participants increased use of chemical barriers and female condoms . CONCLUSIONS : Results support the use of group interventions to increase sexual barrier use and acceptability and decrease sexual risk behavior in both HIV+ and HIV- women Abstract This study assessed and compared the efficacy of culturally tailored behavioral interventions to increase use and acceptability of sexual barrier products among HIV-positive women in Zambia . It also sought to evaluate cultural preferences as facilitators or impediments to potential use of vaginal chemical barriers for sexual risk reduction within the Zambian context . Women ( N=240 ) , recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center , were r and omized into group or individual intervention arms . Participants attended a baseline assessment , three intervention sessions and follow up assessment s at six and 12 months . All participants increased use and acceptability of female condoms and vaginal products and maintained male condom use at six and 12 months . Preliminary data indicated that group participants increased male condom use at six months and trial use and acceptability of female condoms and lubricants predicted their use in the group condition . Results support group interventions to increase sexual barrier use and acceptability in HIV-positive women within the Zambian context . From a public health st and point , groups may represent a cost-effective and culturally congruent intervention OBJECTIVE To develop and test an HIV intervention targeting sex workers and madams in the brothels of Bombay . SUBJECTS AND METHODS In a controlled intervention trial , with measurements before and after the intervention , 334 sex workers and 20 madams were recruited from an intervention site , and 207 and 17 , respectively , from a similar control site , both in red-light areas of Bombay . All sex workers were tested for antibodies to HIV and syphilis , and for hepatitis B surface antigen . Information on sexual practice s , condom use and knowledge of HIV was collected by interviewer-administered question naire . All subjects in the intervention group underwent a 6-month program of educational videos , small group discussion s and pictorial educational material s ; free condoms were also distributed . The blood tests and the question naire were readministered to all subjects at both sites immediately after the intervention . Both groups were followed for approximately 1 year . RESULTS The baseline level of knowledge about HIV and experience with condoms was extremely low among both sex workers and madams . The baseline prevalence of HIV antibodies was 47 % in the intervention group and 41 % in the control group ( P = 0.17 ) . The incidence densities for HIV and sexually transmitted diseases were significantly different in the two groups ( all P < 0.005 ) : 0.05 and 0.16 per person-year of follow-up for HIV , 0.08 and 0.22 per person-year for antibodies to syphilis , and 0.04 and 0.12 per person-year for hepatitis B surface antigen in the intervention and control women , respectively . Following the intervention , women reported increased levels of condom use , and some ( 41 % ) said they were willing to refuse clients who would n't use them . However , both the sex workers and the madams were concerned about losing business if condom use was insisted upon . CONCLUSIONS Both HIV prevalence and incidence are alarmingly high among female sex workers in Bombay . Successful interventions can be developed for these women , and even a partial increase in condom use may decrease the transmission of HIV and sexually transmitted diseases . Intervention programs of longer duration that target madams and clients and make condoms easily available are urgently needed at multiple sites in red-light areas Universal nevirapine ( NVP ) therapy ( provision of the drug without HIV testing ) has been suggested as potentially 
    Output:
    
SRH-HIV linkage interventions were generally considered beneficial and feasible .
The majority of studies showed improvements in all outcomes measured .
While there were some mixed results , there were very few negative findings .
Generally , positive effects were shown for key outcomes , including HIV incidence , sexually transmitted infection incidence , condom use , contraceptive use , uptake of HIV testing and quality of services .