Impact of counselling on safer sex and STD occurrence among STD patients in Malawi.

In developing countries where professional manpower and basic supplies are lacking for STD control, low-cost prevention strategies must be explored. This study assesses the impact of counselling on STD treatment and prevention in Malawi. Increases in safer sex practices are used as indicators of prevention behaviour. A pre-test post-test control group design over a 4-month interval was conducted in 1991 in 2 comparable hospitals approximately 100 km apart. STD was diagnosed symptomatically and Knowledge Attitude Practice and Behaviour (KAPB) data collected using a structured questionnaire. In one group, trained counsellors discussed modes of transmission and prevention of STD/AIDS including a condom demonstration; symptoms and treatment of STDs; partner notification; risk taking and reasons for doing so; and motivations for behaviour change. The results show that counselling reduces the occurrence of STDs; increases concern for sexual partners; increases knowledge about and use of condoms; reduces mean number of partners; and reduces health costs due to fewer hospital visits. Although the observed behaviour change was short term, these outcomes argue in favour of counselling as a low-cost effective strategy for STD control.