Relationships between changes in HIV risk perception and condom use in East Zimbabwe 2003–2013: population-based longitudinal analyses

Abstract

Background: Perceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception. Methods: Data on sexually active, HIV-negative adults (15-54 years) were taken from four surveys of a generalpopulation open-cohort study in Manicaland, Zimbabwe (2003-2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bidirectional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated. Results: One thousand, nine hundred eighty-eight males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 0.85-2.28, PAF = 3.39%; females: aOR = 1.41 [1.06-1.88], PAF = 6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR = 1.76 [1.12-2.78]; females: aOR = 1.23 [0.93-1.62]) compared to those without change in risk perception.

HIV Risk Factors and Risk Perception Among Adolescent Girls and Young Women: Results From a Population-Based Survey in Western Kenya, 2018

“…Overall, just 12.7% of sexually active AGYW in this population had a high HIV risk perception. Factors independently associated with higher risk perception in this population are consistent with other published reports, including not using a condom at first sex 22,59 ; having ever had anal sex 60 ; and having an STI diagnosis, 61 multiple sexual partners, 41,62 and HIV-positive partner or partner with unknown HIV status 13,20,63 in the past 12 months. Notably, however, less than 30% of those diagnosed with an STI in the past 12 months and approximately one-half of those who reported having an HIV-positive sexual partner in the past 12 months reported having a high perceived risk of HIV.…”

“…The observed mismatch between reported behaviors and perception of risk for HIV infection among sexually active AGYW is concerning because individuals with a lower perception of risk have been shown to be less likely to seek or use preventive measures, including HIV pre-exposure prophylaxis, 64 while continuing to engage in behaviors that can put them at risk for HIV infection. 22,23,65 Our study demonstrates that it is possible to identify AGYW who, despite having low risk perception, are at high risk of HIV infection, thereby opening the door for more effective counseling and interventions.…”

“…18 Studies among AGYW in Uganda, 19 Lesotho, 20 and Malawi 13 have shown that although HIV risk perception increases with the number of HIV risk factors, a substantial proportion of AGYW with multiple risk factors for HIV have low risk perception. 13,21,22 In Malawi, studies have further shown that AGYW who perceive themselves to be at low risk of HIV acquisition minimally seek, or use, protective measures. 13,23 Similar to other countries in SSA, HIV prevalence among AGYW in Kenya is 2-fold higher than that among ABYM (2.6% vs. 1.3%).…”

Representações sociais de adolescentes sobre a transmissão do HIV/AIDS nas relações sexuais: vulnerabilidades e riscos

“…Vale destacar que essa noção das vulnerabilidades permite a proposição de que políticas públicas podem impactar a prevenção do HIV, tendo em vista que apenas o conhecimento dos riscos não implica em mudanças de atitude e comportamentos, diante dos muitos fatores biopsicossociais que influenciam, como apontaram os achados de um estudo longitudinal realizado no Zimbábue 24 .…”

Perceived Risk of HIV Infection and Acceptability of PrEP among Men Who Have Sex with Men in Brazil

“…Condom use is long known to be effective and associated with safer sex among MSM (Klein & Kaplan, 2012 ). Shaefer et al (Schaefer et al, 2020 ) reported an association of high-risk perception of HIV and lack of condom use and also showed that an increase in condom use leads to a decrease in risk perception. However, a direct correlation between risk perception and real risk of HIV is highly complex (Plotzker et al, 2017 ), since other studies have shown that individuals at higher risk may perceive themselves at low or no risk of infection (Khawcharoenporn et al, 2019 ; MacKellar et al, 2007 ; Rutstein et al, 2020 ).…”