Testing for HIV does not increase condom use – but testing HIV positive does

24 November 2020

Evidence review suggests enhanced testing services, which offer things such as counselling or support groups, are having little impact on condom use.

Image of an HIV self-testing kit

In a major evidence review, carried out to inform an update of World Health Organization (WHO) HIV testing guidelines, researchers found that the act of getting an HIV test did not result in people subsequently using more condoms more often - even in settings where they received enhanced testing services such as counselling. However, they did find that people who tested positive for HIV were more likely to use condoms following their result.

The review analysed 76 studies published between 2010 and 2019. Researchers looked at three different types of studies. The first compared standard testing services, where basic pre‐test information and counselling is provided, against services offering more intensive support through things such as enhanced counselling, support groups, HIV self‐testing or community‐based testing. Studies that compared any kind of testing-related services against no testing services and those that assessed people's behaviour in the months before and after testing were also analysed.

No significant difference was found in condom use among people who received enhanced HIV testing services compared to those who received standard services or no testing-related services. There were some exceptions to this. For instance, two large studies enrolled women who sell sex and women at higher risk of HIV. Both found enhanced HIV testing led to increases in condom use during vaginal sex, although not for anal sex.

The finding that people are more likely to use condoms after testing HIV-positive was most clear among heterosexual couples where a six-fold increase in condom use was found. But it was also consistent among marginalised groups such as men who have sex with men. This indicates it is an HIV‐positive diagnosis, not the act of testing that has an impact on later behaviour.

The analysis did not establish whether people newly diagnosed with HIV continue to use condoms beyond a few months of diagnosis as studies only tracked people up to six months. But several studies reported decreases during this time, which may suggest the increase in condom use is only temporary.

This review is the third to show that receiving an HIV‐negative diagnosis does not increase condom use. As with all the review's findings, there were some notable exceptions, such as a Chinese trial that increased condom use after providing enhanced counselling, videos and ‘safe sex bracelets’ to HIV-negative men who have sex with men.

Twelve studies reported how many sex partners people had before and after testing. Those who received enhanced testing services had 0.28 fewer sex partners at follow‐up than those who received standard services, although this was not statistically significant. Some studies found that people who tested HIV positive reported fewer sex partners at follow up, although not all studies of this kind reported this.

Most studies found no significant differences in HIV or STI infections among those who received enhanced testing services compared to those who did not. This is likely to reflect the minimal impact enhanced testing services are having on condom use. Again, there were exceptions as three community‐based studies found reductions in HIV incidence, ranging from slight to significant, among people who received intensive testing services.

These findings suggest it may be more useful to invest limited resources in HIV testing strategies that focus on early diagnosis, treatment and prevention, rather than in enhanced testing services.

But it is important to note that several studies found increases in condom use or decreases in sex partners among higher-risk groups as a result of more intensive approaches, suggesting they may still be of great value for certain groups or within particular settings.

Written by Hester Phillips