To assess sexual behavior changes after voluntary HIV testing and routine counseling, we interviewed 235 persons at 2 anonymous test sites in North Carolina. Among the 57 (24%) persons returning for follow-up 1 year later, 70% were male; 44% were black, 37% were homosexual, 10% were bisexual; and 16% were HIV positive. Overall, 28% of returnees at the initial visit and 33% on the follow-up visit admitted to having 2 or more sexual partners in the past month. At the initial interview and at follow-up, 21% of returnees reported condom use in the past month. Homosexual men were significantly less likely to use condoms during anal sex over time (58% non-use initially vs. 74% non-use at follow-up, p = 0.04). No significant net change in high-risk sexual behaviors was found at follow-up. Overall findings indicate that the standard HIV testing and counseling provided by health departments anonymously and free of charge does not result in elimination of high-risk sexual behaviors or initiation of safer sex behaviors among those at high risk for HIV infection.