Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

Abstract

BackgroundRisk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use.ObjectivesThis systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use.Data sourcesWe searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance.Study eligibility criteriaPeer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included.Study appraisal and synthesis methodsIncluded publications were quality assessed using the Hawker method and coded thematically.Results10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may—or may not—choose to use prevention interventions.LimitationsThis literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings.Conclusions and implicationsWhen considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection.

How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use pre-exposure prophylaxis

“…Having a steady partner was also associated with increased odds of high-risk behavior. Risk perception decreases when feelings of trust grow in relationships [48]. Accordingly, MSM may feel more comfortable to have condomless sex with a steady partner and may perceive no or low risk with this behavior [49].…”

Prevalence and correlates of HIV infection among people who use drugs in Cambodia: a cross-sectional survey using respondent driven sampling method

“…HIV was more likely to occur among these PWUD who perceived that they were at high HIV risk, perhaps based on their sexual behaviors, which is not necessarily surprising. Perception of risk has been shown to influence the uptake of HIV prevention interventions [29], and to act in association with contextual factors to influence the risk of HIV infection [30]. As noted in Table 5, the majority of the respondents in this survey had been reached with a range of community-based HIV programs, including risk reduction education interventions and education related to their risks.…”

Acceptability of oral HIV self-testing among female sex workers in Gaborone, Botswana

“…This recommendation could be as a result of general mistrust and/or as a result of the perceived stigma and discrimination against FSW from authorities. [41,42] Addressing this recommendation could potentially improve social integration of the FSW communities which might in turn have a bearing on other health seeking behaviours.…”