Perceived risk versus objectively measured risk of HIV acquisition: a cross-sectional study among HIV-negative individuals in Serodiscordant partnerships with clients attending an Urban Clinic in Uganda

Perceived versus actual HIV risk among PrEP indicated persons with criminal legal involvement

Individuals involved with community supervision experience multi-level obstacles impacting health outcomes. This is a high-risk period for HIV acquisition due to potential reengagement in unprotected sex and/or unsafe injection drug practices. This study aimed to assess the congruence between actual and perceived HIV risk and the degree to which individual, social, and behavioral factors impact risk perception among individuals on community supervision. While all participants were clinically indicated for PrEP, most participants (81.5%) did not consider themselves at risk for HIV (69.5%) or were not sure of their risk (12.0%). Among those with no or unsure perceived risk, 94% engaged in sexual behaviors that put them at-risk of HIV. Perceived HIV risk was associated with sharing injection equipment (aPR = 1.8, 95% CI [1.02, 3.3]), identifying as a sexual minority (aPR = 2.3, 95% CI [1.3, 3.9]), and having sex with a partner living with HIV (aPR = 2.4, 95% CI [1.3, 4.3]). Having sex with a partner living with HIV was the only sexual risk behavior associated with a perceived risk of HIV. These findings indicate a substantial discrepancy between actual and perceived HIV risk, highlighting the need for targeted interventions to improve risk perception accuracy and enhance risk prevention among individuals on community supervision.

Examining concordance of sexual-related factors and PrEP eligibility with HIV risk perception among adolescent girls and young women: cross-sectional insights from DREAMS sites in Kenya, Malawi, and Zambia

BACKGROUND

HIV risk perception is an important cognition for prevention, theoretically engendering service-seeking and risk-reduction behaviors, but its composition remains poorly understood. We examined country-specific correlates of self-appraised HIV exposure risk among sexually active adolescent girls and young women (AGYW, aged 15-24 years) without HIV in Kenya, Malawi, and Zambia. We also explored overlaps between self-appraised HIV exposure risk and pre-exposure prophylaxis (PrEP) eligibility to identify engagement opportunities.

METHODS

We analyzed cross-sectional data (2016/2017) to estimate sexual-related correlates of self-appraised HIV exposure risk (likely vs. not, temporally framed as "ever") using log-Poisson models with robust standard errors. For sexual-related factors with an unadjusted p ≤ 0.10, individual adjusted models were fitted, controlling for sociodemographic and cognitive factors with an unadjusted p ≤ 0.10. PrEP eligibility was defined using national guidelines; since conditional criteria are in Malawi's (age-disparate sex + ever-pregnant) and Zambia's (multiple partners + condomless sex) guidelines, we also assessed PrEP eligibility after decoupling these factors.

RESULTS

Few AGYW reported likely HIV exposures (Kenya [N = 746]: 15.7%, Malawi [N = 1348]: 46.2%, Zambia [N = 349]: 9.5%) despite ubiquitous HIV risk (98.7%, 99.8%, and 98.9% of Kenyan, Malawian, and Zambian AGYW reported ≥ 1 sexual-related factor). However, the adjusted models found some actual-perceived risk concordance. Positive correlates of self-appraised likely HIV exposures included partner(s)' likely HIV exposure (all countries); partner(s)' unknown HIV status and other partners (Kenya, Malawi); STI symptoms and partner(s) living outside the community (Kenya); non-partner sexual violence (Zambia); and transactional sex, multiple partners, pre-coital alcohol use, and physical/sexual intimate partner violence (Malawi). Per national guidelines, PrEP eligibility criteria differentially identified HIV risk (Kenya: 93.6%, Malawi: 53.3%, Zambia: 44.6%), and self-appraised likely HIV exposures were low among PrEP-eligible AGYW (Kenya: 16.5%, Malawi: 48.5%, Zambia: 18.8%). Decoupling Malawi's and Zambia's conditional PrEP criteria could increase risk identification to > 85% and potential engagement by ~ 70% and ~ 30%, respectively.

CONCLUSIONS

AGYW's HIV risk perceptions were mostly influenced by factors beyond their locus of control. Conditional PrEP eligibility criteria may inhibit AGYW's access and uptake in some settings: countries should consider decoupling these factors to minimize barriers. Intersections between autonomy, behaviors, and perceptions among AGYW in gender-inequitable settings warrants further investigation.

Awareness and openness to the use of PrEP among a nationally representative sample of South African adults

Introduction

South Africa adopted for pre-exposure prophylaxis (PrEP) in 2016, becoming the first African country to do so. Yet to date, uptake has been underwhelming, only about 165,000 South Africans were reported to be on PrEP in mid-2021. Lack of awareness has been cited as a contributory factor for the low uptake, but this has never been examined using a nationally representative sample.

Methods

we investigated this among a national sample of HIV seronegative adults. Data were from the 2017/2018 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. Awareness and openness to using PrEP were self-reported. Weighted percentages were calculated overall and by demographic characteristics.

Results

overall, only 3.2% of seronegative adults spontaneously reported PrEP as a way of preventing HIV. Overall, 69.6% were open to using PrEP, from 58.2% in Western Cape, to 78.5% Northern Cape. Openness was highest among the youngest age group (18-29 years, 78.3%) and lowest among the oldest (60+ years, 45.6%). Striking racial differences were observed with openness among Black Africans (75.4%) being 2.5 times higher than Whites (29.0%). Among women, openness was 64.7% among those currently pregnant, 80.4% among those pregnant in the past two years but not now, and 67.8% among those who were not pregnant in the past two years (χ(2)=134.2, p<0.001). Among males, openness was higher among those circumcised (75.6%) than uncircumcised (64.5%).

Conclusion

planning for broad-scale implementation of PrEP within the South African context could build on knowledge gained from recent implementation and scale-up of relevant biomedical interventions (e.g. ART, voluntary medical male circumcision, and family planning).

Associations between perceived and actual risk of HIV infection and HIV prevention services uptake among men who have sex with men in Shandong province, China: a cross-sectional study

BACKGROUND

Associations between perceived and actual risk of HIV infection and HIV prevention services uptake are inconclusive. This study aimed to evaluate the discrepancy between the perceived and actual HIV risk, and quantify the associations between perceived and actual risk of HIV infection and three HIV prevention services utilization among men who have sex with men (MSM) in Shandong province, China.

METHODS

A cross-sectional study was conducted in Shandong province in June 2021. Participants were eligible if they were born biologically male, aged 18 years or older, had negative or unknown HIV status, and had sex with men in the past year. Participants were recruited online. The discrepancy between their perceived and actual risk of HIV infection was evaluated by calculating the Kappa value. Bayesian model averaging was used to assess the associations between perceived and actual risk of HIV infection and HIV prevention services uptake.

RESULTS

A total of 1136 MSM were recruited, most of them were 30 years old or younger (59.9%), single (79.5%), with at least college education level (74.7%). Most participants (97.4%) perceived that they had low risk of HIV infection, and 14.1% were assessed with high actual risk. The discrepancy between their perceived and actual risk of HIV infection was evaluated with a Kappa value of 0.076 (P < 0.001). HIV testing uptake had a weak association with perceived high HIV prevalence among social networks (aOR = 1.156, post probability = 0.547). The perceived high HIV prevalence among national MSM was positive related to willingness to use PrEP (aOR = 1.903, post probability = 0.943) and PEP (aOR = 1.737, post probability = 0.829). Perceived personal risk (aOR = 4.486, post probability = 0.994) and perceived HIV prevalence among social networks (aOR = 1.280, post probability = 0.572) were related to history of using PrEP. Perceived personal risk (aOR = 3.144, post probability = 0.952), actual risk (aOR = 1.890, post probability = 0.950), and perceived risk among social networks (aOR = 1.502, post probability = 0.786) were related to history of using PEP.

CONCLUSIONS

There is discordance between perceived and actual personal risk of HIV infection among MSM in China. HIV risk assessment and education on HIV prevalence among MSM should be strengthened to assist high-risk populations aware their risk accurately and hence access HIV prevention services proactively.

Exploring the long-term sequelae of childhood sexual abuse on risky sexual behavior among Chinese transgender women

Introduction

Childhood sexual abuse (CSA) is a hidden but serious public health issue that can lead to a series of behavioral consequences and health problems in adulthood. It has been well documented that transgender women (TGW) have a high prevalence of CSA victimization. Moreover, risky sexual behaviors are also widespread among TGW; nevertheless, research investigating the associations between CSA victimization and risky sexual behaviors in TGW represents a gap in the literature.

Methods

Our research was carried out mainly in Shenyang of China from November 2018 to January 2019. Sociodemographic characteristics, as well as information on participants' HIV awareness and sexual behaviors, were collected through face-to-face interviews. The impact of CSA was examined through hierarchical logistic regression, adjusted for sociodemographic factors and HIV awareness.

Results

In the sample of 247 adult TGW, 14.2% of them had a CSA history. In the previous 6 months, 30.8% of the participants reported condomless anal intercourse (CAI) and 38.5% of them had multiple sexual partners (MSP). The findings demonstrated that TGW with CSA history were more likely to take part in CAI (p = 0.001, OR = 4.252) or have MSP (p = 0.004, OR = 3.260) in adulthood. Furthermore, HIV knowledge was not a predictor of CAI or MSP, but higher HIV risk perception was associated with a greater probability of CAI.

Conclusion

Transgender women with a history of CSA were more prone to engage in CAI and have MSP in China.

Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: a cross-sectional study

BACKGROUND

HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model.

METHODS

This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018-2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD.

RESULTS

Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27-0.60), heterosexual men (AOR = 0.45, 95% CI:0.33-0.61) and women (AOR = 0.26, 95% CI:0.19-0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30-1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10-8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08-1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26-1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04-1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59-0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60-0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07-3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15-1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18-1.66) increased the chance of exhibiting RD.

CONCLUSIONS

Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.

Implementing a Status-Neutral Approach to HIV in the Asia-Pacific

PURPOSE OF REVIEW

Globally, "undetectable equals untransmittable (U=U)" and "pre-exposure prophylaxis (PrEP)" have become crucial elements in HIV treatment and prevention programs. We reviewed the implementation of U=U and PrEP among countries in the Asia-Pacific region.

RECENT FINDINGS

U=U and PrEP uptakes were limited and slow in the Asia-Pacific. Inadequate knowledge among health care practitioners and pervasive stigma towards individuals living with HIV and their sexual lives are key barriers for the integration of U=U into clinical practice. Paternalistic and hierarchical health care systems are major obstacles in PrEP implementation and scale-up. Countries with the most advanced PrEP implementation all use community-based, nurse-led, and key population-led service delivery models. To advance U=U and PrEP in the Asia-Pacific, strategies targeting changes to practice norm through wide-scale stakeholders' training and education, making use of online health care professional influencers, and utilizing financial mechanism should be further explored through implementation research.