Effect of perceived HIV risk on initiation of antiretroviral therapy during the universal test and treat era in South Africa

Abstract Background South Africa has not achieved the 90–90–90 goals, in part due to low rates of antiretroviral therapy (ART) initiation among those aware of their HIV status. Perceived risk of HIV at the time of testing may affect likelihood of rapid ART initiation. The purpose of this study was to evaluate factors associated with perceived risk of HIV and the relationship between perceived HIV risk and rapid ART initiation during the universal test and treat era which was adapted in October 2016. Methods We conducted a prospective study of adults undergoing HIV testing from October 2016–February 2019 at Ithembalabantu Clinic in Durban. Eligible participants reported not previously being diagnosed with HIV. Before HIV testing, participants were asked to assess their perceived HIV risk on a four-level scale. We categorized “definitely not” and “probably not going to acquire HIV” as a low perceived risk, and “probably will” and “definitely will become HIV-infected” as a high perceived risk of HIV infection. Participants were followed for up to 14 months following HIV testing to assess ART initiation. Results Among 1519 people newly diagnosed with HIV, 55% were female and mean age was 33 years. Among those, 1382 (90.9%) had a high HIV risk perception and 137 (9.1%) reported low HIV risk perception. In the low risk group individuals were more likely to be female (58% vs 55%), unemployed (62% vs 59%), have a partner with unknown HIV status (61% vs 55%) compared to the high risk group. 83.2% of those with low HIV risk perception reported previously HIV testing compared 91.5% of those with high HIV risk perception. In the multivariate model, males were associated with a higher chances of initiating ART compared to females (adjusted hazard ratio (aHR): 1.187, CI 1.187 (1.060–1.329) and being unemployed (aHR 0.767 CI (0.650–0.905). Those with a low HIV risk perception were less likely to initiate ART 125 (91%) vs 1310 (95%) p = 0.022), and took longer to initiate on ART after HIV diagnosis (11 days’ vs 4 days, p = 0.042). Conclusion Factors associated with high HIV risk perception included being unemployed, single, and having a partner of unknown HIV status. People living with HIV (PLHIV) in South Africa who had a low self-perceived risk to HIV infection were less likely to initiate ART. Assessing self-perceived risk of HIV infection may help direct counselling and improve ART initiation to achieve universal 90–90–90 goal.

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HIV Risk Perception among HIV Negative or Status-Unknown Men Who Have Sex with Men in China

BioMed Research International ◽

10.1155/2014/232451 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Wensheng Fan ◽

Lu Yin ◽

Han-Zhu Qian ◽

Dongliang Li ◽

Yiming Shao ◽

...

Keyword(s):

Risk Perception ◽

High Risk ◽

Hiv Infection ◽

Hiv Testing ◽

Hiv Risk ◽

Perceived Risk ◽

Reference Group ◽

Full Time ◽

Hiv Risk Perception ◽

Hiv Negative

Objective.To evaluate HIV risk perception and its associated factors among Chinese MSM.Methods.A cross-sectional study was conducted among MSM with an HIV negative or unknown status in Beijing, China, between 2011 and 2012. A questionnaire interview was conducted and a blood sample was collected for HIV and syphilis testing.Results.Of 887 MSM who reported they were HIV negative or did not know their HIV status before recruitment, only 7.3% reported a high risk of HIV infection, 28.0% medium risk, 52.2% low risk, and 12.5% no risk. In multivariate logistic regression models using those who reported a medium self-perceived risk as a reference group, self-reported high risk of HIV perception was associated with minority ethnicity (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.03–8.19), self-reported history of sexually transmitted diseases (OR: 2.27; 95% CI: 1.25–4.10), and HIV testing times since the last HIV testing (OR: 0.47; 95% CI: 0.26–0.84); low self-perceived risk of HIV infection was related to full-time employment (OR: 1.58; 95% CI: 1.15–2.18) and illicit drug use (OR: 0.28; 95% CI: 0.10–0.75).Conclusions.The HIV/AIDS epidemic is rapidly rising among Beijing MSM, but more than half MSM did not perceive this risk.

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Concerns about contracting HIV, knowing partners’ HIV sero-status and discussion of HIV/STI with sexual partners as determinants of uptake of HIV testing

Journal of Biosocial Science ◽

10.1017/s0021932018000330 ◽

2018 ◽

Vol 51 (4) ◽

pp. 549-561 ◽

Cited By ~ 5

Author(s):

Anthony Idowu Ajayi ◽

Abdulazeez Olumide Abioye ◽

Oladele Vincent Adeniyi ◽

Wilson Akpan

Keyword(s):

Young Adults ◽

Risk Perception ◽

Hiv Testing ◽

Hiv Risk ◽

Sexual Partners ◽

Adolescents And Young Adults ◽

Hiv Status ◽

Open Communication ◽

Testing Uptake ◽

Hiv Risk Perception

AbstractWorldwide, adolescents and young adults (aged 15–25 years) account for the highest proportion of new HIV infections, yet the uptake of HIV testing among this cohort is sub-optimal. Understanding factors that predict the uptake of HIV testing among adolescents and young adults is critical for designing effective and relevant interventions to increase testing. Drawing from the psychosocial constructs of the Health Belief Model, the study examined the effects of HIV risk perception, discussion of HIV with partners and knowing partners’ HIV status on HIV testing uptake among adolescents and young adults in two Nigerian universities. The study was conducted in 2018 and was cross-sectional in design, with a final sample of 784 male and female students selected using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the effect of HIV risk perception, discussion of HIV with partners and knowing partners’ HIV status on HIV testing uptake. Only 50.6% of participants had ever tested for HIV with 30.7% being tested in the last year, with no significant differences by sex. After controlling for other covariates (age, sex and being sexually active), knowing partners’ HIV status, having discussed HIV with partners and being very concerned about contracting HIV were found to be significantly associated with ever being tested for HIV and recent HIV testing uptake. Uptake of HIV testing was found to be low in the study setting and fell short of the first ‘90%’ UNAIDS target. Age-appropriate strategies, targeting open communication on HIV/STIs and disclosure of sero-status between sexual partners are required to promote uptake of HIV testing among young adults and adolescents in Nigeria.

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Measuring HIV Risk Perception and Behavior: Results from Round 1 of the Cognitive Interviewing Project with young women and men who have sex with men in South Africa

AIDS and Behavior ◽

10.1007/s10461-020-02790-9 ◽

2020 ◽

Vol 24 (8) ◽

pp. 2307-2318

Author(s):

Jessica Milne ◽

Hannah Brady ◽

Thembekile Shato ◽

Danielle Bohn ◽

Makhosazana Mdladla ◽

...

Keyword(s):

South Africa ◽

Risk Perception ◽

Young Women ◽

Hiv Risk ◽

Cognitive Interviewing ◽

Hiv Risk Perception ◽

Sex With Men ◽

And Behavior

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Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa

AIDS and Behavior ◽

10.1007/s10461-021-03171-6 ◽

2021 ◽

Author(s):

Dorina Onoya ◽

Tembeka Sineke ◽

Idah Mokhele ◽

Jacob Bor ◽

Matthew P. Fox ◽

...

Keyword(s):

South Africa ◽

Hiv Testing ◽

Self Report ◽

Hiv Diagnosis ◽

Adjusted Risk ◽

Art Initiation ◽

Art Policy ◽

Universal Test And Treat ◽

Post Test ◽

Treat All

AbstractWe aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30–39.9 vs 18–29.9 years, 95% confidence intervals (CI): 1.0–2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4–3.6) and HIV testing history (aRR 1.7 for > 12 months vs < 12 months/no prior test, 95% CI: 1.0–2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4–3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2–18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2–0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2–3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.

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1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1494 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S595-S595

Author(s):

Hampton Ocon ◽

Samir Sabbag

Keyword(s):

Public Health ◽

High Risk ◽

Hiv Infection ◽

Hiv Testing ◽

Hiv Risk ◽

Perceived Risk ◽

Health Initiatives ◽

History Of ◽

Sex With Men ◽

Public Health Initiatives

Abstract Background According to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection. Methods In an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing. Results Of the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595). Conclusion This suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk. Disclosures All authors: No reported disclosures.

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HIV risk perception and consistency in condom use among adolescents and young adults in urban Cape Town, South Africa: a cumulative risk analysis

Southern African Journal of Infectious Diseases ◽

10.1080/23120053.2017.1332800 ◽

2017 ◽

Vol 32 (3) ◽

pp. 105-110 ◽

Cited By ~ 5

Author(s):

Evans Muchiri ◽

Clifford Odimegwu ◽

Nicole De Wet

Keyword(s):

South Africa ◽

Young Adults ◽

Risk Perception ◽

Risk Analysis ◽

Condom Use ◽

Hiv Risk ◽

Cumulative Risk ◽

Cape Town ◽

Adolescents And Young Adults ◽

Hiv Risk Perception

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HIV risk perception and consistency in condom use among adolescents and young adults in urban Cape Town, South Africa: a cumulative risk analysis

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v32i3.48 ◽

2017 ◽

Vol 32 (3) ◽

pp. 105-110

Author(s):

Evans Muchiri ◽

Clifford Odimegwu ◽

Nicole De Wet

Keyword(s):

Risk Factors ◽

Young Adults ◽

Risk Perception ◽

Hiv Infection ◽

Condom Use ◽

Hiv Risk ◽

Cumulative Risk ◽

Cape Town ◽

Adolescents And Young Adults ◽

Hiv Risk Perception

Background: The relationship between HIV risk perception and consistency in the use of condoms is scarcely understood in the context of a high HIV prevalence among adolescents and young adults in urban South Africa.Methods: Using data from Cape Area Panel Study (CAPS), gender-stratified analyses were conducted to determine relationship between risk perception and condom use among 14–22 year olds (n = 4 853) in urban Cape Town. Using discriminant function analyses, ecological determinants of consistency in condom use were determined and a cumulative risk approach examined. Results: A total of 1 598 sexually active youths, of mean age 17.7 years, with 785 (49%) of males and 813 (51%) females were identified for analyses. At baseline, 87% of males and 90% of females assessed themselves to be at no or low risk of HIV infection. At follow-up, 61% of males reporting low or no risk were consistently using condoms compared to 67% reporting some risk of HIV infection. In females, 47% reporting low or no risk consistently used condoms compared to 49% of those reporting to be at some risk.Conclusions: Perceived risk for HIV infection had no significant impact on consistency in using condoms for both males and females. Further, findings suggests that the effect of ecological risk factors was cumulative. Therefore, interventions aimed at the three levels ecology may be more effective in improving consistency as risk factors possess a cumulative effect.

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The Rhythm of Risk: Sexual Behaviour, PrEP Use and HIV Risk Perception Between 1999 and 2018 Among Men Who Have Sex with Men in Amsterdam, The Netherlands

AIDS and Behavior ◽

10.1007/s10461-020-03109-4 ◽

2020 ◽

Author(s):

Maartje Basten ◽

Chantal den Daas ◽

Janneke C. M. Heijne ◽

Anders Boyd ◽

Udi Davidovich ◽

...

Keyword(s):

Risk Perception ◽

Hiv Risk ◽

Perceived Risk ◽

Anal Intercourse ◽

Steady Partner ◽

The Past ◽

Condomless Anal Intercourse ◽

Hiv Risk Perception ◽

Risk Sexual Behaviour ◽

Sex With Men

AbstractHIV risk perception plays a crucial role in the uptake of preventive strategies. We investigated how risk perception and its determinants changed between 1999 and 2018 in an open, prospective cohort of 1323 HIV-negative men who have sex with men (MSM). Risk perception, defined as the perceived likelihood of acquiring HIV in the past 6 months, changed over time: being relatively lower in 2008–2011, higher in 2012–2016, and again lower in 2017–2018. Irrespective of calendar year, condomless anal intercourse (AI) with casual partners and high numbers of partners were associated with higher risk perception. In 2017–2018, condomless receptive AI with a partner living with HIV was no longer associated with risk perception, while PrEP use and condomless AI with a steady partner were associated with lower risk perception. We showed that risk perception has fluctuated among MSM in the past 20 years. The Undetectable equals Untransmittable statement and PrEP coincided with lower perceived risk.

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