Time for change: Transitions between HIV risk levels and determinants of behavior change in men who have sex with men

As individual sexual behavior is variable over time, the timing of interventions might be vital to reducing HIV transmission. We aimed to investigate transitions between HIV risk levels among men who have sex with men (MSM), and identify determinants associated with behavior change. Participants in a longitudinal cohort study among HIV-negative MSM (Amsterdam Cohort Studies) completed questionnaires about their sexual behavior during biannual visits (2008–2017). Visits were assigned to different HIV risk levels, based on latent classes of behavior. We modelled transitions between risk levels, and identified determinants associated with these transitions at the visit preceding the transition using multi-state Markov models. Based on 7,865 visits of 767 participants, we classified three risk levels: low (73% of visits), medium (22%), and high risk (5%). For MSM at low risk, the six-month probability of increasing risk was 0.11. For MSM at medium risk, the probability of increasing to high risk was 0.08, while the probability of decreasing to low risk was 0.33. For MSM at high risk, the probability of decreasing risk was 0.43. Chemsex, erection stimulants and poppers, high HIV risk perception, and recent STI diagnosis were associated with increased risk at the next visit. High HIV risk perception and young age were associated with decreasing risk. Although the majority of MSM showed no behavior change, a considerable proportion increased HIV risk. Determinants associated with behavior change may help to identify MSM who are likely to increase risk in the near future and target interventions at these individuals, thereby reducing HIV transmission.

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

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.

The mediated effect of HIV risk perception in the relationship between peer education and HIV testing uptake among three key populations in China

Background Peer education and HIV risk perception are related to HIV testing uptake among key populations. We aimed to examine the association between peer education, HIV risk perception, and HIV testing uptake, as well as to evaluate the mediated effect of HIV risk perception in the relationship between peer education and HIV testing uptake. Methods We conducted a cross-sectional survey among 1188 HIV-uninfected or unknown participants from populations of men who have sex with men (MSM), female sex workers (FSWs), and drug users (DUs) in seven cities of China. Partial correlation analysis and regression analysis were employed to examine the associations among peer education, HIV risk perception, and HIV testing uptake. Mediation analysis was conducted to assess whether HIV risk perception mediated the hypothesized association. Results Receiving peer education was associated with higher odds of HIV testing uptake among MSM, FSWs and DUs. Perceiving risk of HIV infection was associated with higher odds of HIV testing uptake among MSM and DUs. Among MSM, the relationship between peer education and HIV testing uptake was mediated by moderate risk perception of HIV (indirect effect: 0.53, 95% CI 0.07 to 1.21), and by high risk perception of HIV (indirect effect: 0.50, 95% CI 0.01 to 1.17). Among DUs, the relationship between peer education and HIV testing uptake was mediated by moderate risk perception of HIV (indirect effect: 1.80, 95% CI 0.57 to 3.45). Conclusions Participants who received peer education tended to perceive their risk of HIV infection, which in turn was associated with increased HIV testing uptake among MSM and DUs. Therefore, in addition to peer education interventions, more report about HIV epidemic and risk assessment should also be scaled up to enhance HIV risk perception among key populations.

Effects of Training on HIV Risk Perception, Knowledge and Sexual Behaviour Among Fisherfolks in Two Communities in North Central Nigeria

Fisherfolks participate in unsafe sexual behaviors which can predispose them to HIV infection. This research was designed to assess the effects of training on HIV/AIDS-related knowledge and sexual behavior among fisherfolks in two fishing communities in Nigeria. Respondents were allocated into Experimental Group (EG, n = 103) and Control Group (CG, n = 105). Data were collected at baseline using a questionnaire which included questions on socio-demographic characteristics, sexual behavior among others. A 3-day HIV/AIDS training was conducted for EG. Fisherfolks in EG and CG with good knowledge were 16.5% and 54.3%, respectively at baseline. The number increased to 100.0% in EG than CG (60%) at follow-up. At baseline, fisherfolks in EG and CG with high riskperception scores were 26.2% and 59.0%, respectively; corresponding figures at post intervention for EG and CG were 100.0% and 70.0% respectively. Training increased HIV/AIDS knowledge, improved risk perception and reduced risky sexual practices among fisherfolks.

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

HIV 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.

The Effect of Selected Demographic Parameters on Intimacy, HIV risk perception and Self-efficacy among Ugandan and Tanzanian University Pre-Service Teachers.

The study was conducted among university pre-service teachers pursuing Bachelor of Arts/Bachelor of Science with Education degree programmes, with the major aim of analysing the effect selected demographic attributes or parameters of gender, age and religion on intimacy, HIV risk perception and self-efficacy. A total of 557 respondents selected using systematic random sampling from both Makerere University School of Education (Uganda) and Dar es Salaam University College of Education (Tanzania) were studied and findings revealed that the variation intimacy among the two genders was not significant while the variation in HIV risk perception between the male and female pre-service teachers was significant. It was also observed that the variation in self-efficacy between the two genders was not significant. On the other hand, the, the variation in intimacy between the age cohorts under study was significant while that in HIV risk perception and self-efficacy for the different age groups was not significant. The variations in intimacy, HIV risk perception and self-efficacy between the several religions was found to be non-significant across all religions. The findings therefore point to the need for effective university policies that should incorporate life skills education, HIV workshops, behaviour change programmes, peer education and exemplary leadership.

Associations Among HIV Risk Perception, Sexual Health Efficacy, and Intent to Use PrEP Among Women: An Application of the Risk Perception Attitude Framework

HIV risk perception is a known determinant of HIV prevention behaviors among vulnerable populations. Lesser known is the combined influence of risk perception and efficacy beliefs on PrEP use. We examined the associations between levels of risk perception and strength of efficacy beliefs on intent to use PrEP in a sample of adult Black and Latina women. Guided by the risk perception attitudes (RPA) framework, we used cluster analysis to identify four interpretable groups. We ran analysis of covariance models to determine the relationship between membership in the RPA framework groups and intention to use PrEP. Among the 908 women, the mean age was 29.9 years and participants were Latina (69.4%) and Black (25.6%). Results of the analysis show that women with low perception of HIV risk and strong efficacy beliefs had significantly less intent to use PrEP than women with high risk perception and weak efficacy beliefs.

Identifying Barriers to Condom Use Among Female Sex Workers: a Systematic Review and Meta-analysis

Background: Many studies have shown a lot of factors which are as barriers to the condom use among female sex workers (FSWs). However, there is not a comprehensive study to report the number and magnitude of these barriers. This study aimed to resolve this gap by comprehensive systematic review and meta-analysis. Methods: We have searched the electronic databases include Web of Science, PubMed, and Scopus until September 2019. For each database we formulated a separate search strategy using keywords such as “condom use” and “sex worker” and the related synonyms. Epidemiological epidemiology addressed the factors associated with unprotected sex for the female sex worker. The heterogeneity across studies and probability of publication bias was investigated by I2 statistic and Begg's and Egger's tests respectively. The pooled effect size were expressed as odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model.Results: Out of 5854 studies obtained in initial search, 35 studies with sample size 14218 participants had eligibility criteria which were included in the final analysis. Ten factors include marital status, alcohol use, history of violence, history of sexual abuse, history of STIs, STIs knowledge, HIV risk perception, drug use, knowledge about the condom use, condom use self-efficacy were identified in those studies. History of sexual abuse with OR=1.87 and the knowledge on AIDS with OR=1.07 had the strongest association and weakest association with condom use respectively. Conclusion: Many factors with different degrees of association influence on the condom use among female sex workers. However, history of sexual abuse, a history of violence, and HIV risk perception were considered as the major determinants of the condom use. The structural interventions, policy change and empowerment of female sex workers are recommended to increase consistent condom use in FSWs.