Accuracy and determinants of perceived HIV risk among young women in South Africa

Brendan Maughan-Brown,Atheendar S Venkataramani

doi:10.1186/s12889-017-4593-0

Brendan Maughan-Brown, Atheendar S Venkataramani

Open Access

https://doi.org/10.1186/s12889-017-4593-0

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Abstract

BackgroundHIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDS-free generation – including reaching the UNAIDS 90–90-90 target – thus depends critically on the content of these perceptions. We examined the accuracy of HIV-risk perceptions and their correlates among young black women in South Africa, a group with one of the highest HIV incidence rates worldwide.MethodsWe used individual-level longitudinal data from the Cape Area Panel Study (CAPS) from 2005 to 2009 on black African women (20–30 years old in 2009) to assess the association between perceived HIV-risk in 2005 and the probability of testing HIV-positive four years later. We then estimated multivariable logistic regressions using cross-sectional data from the 2009 CAPS wave to assess the relationship between risk perceptions and a wide range of demographic, sexual behaviour and psychosocial covariates of perceived HIV-risk.ResultsWe found that the proportion testing HIV-positive in 2009 was almost identical across perceived risk categories in 2005 (no, small, moderate, great) (χ2 = 1.43, p = 0.85). Consistent with epidemiologic risk factors, the likelihood of reporting moderate or great HIV-risk perceptions was associated with condom-use (aOR: 0.57; 95% CI: 0.36, 0.89; p < 0.01); having ≥3 lifetime partners (aOR: 2.38, 95% CI: 1.53, 3.73; p < 0.01); knowledge of one’s partner’s HIV status (aOR: 0.67; 95% CI: 0.43, 1.07; p = 0.09); and being in an age-disparate partnerships (aOR: 1.73; 95% CI: 1.09, 2.76; p = 0.02). However, the likelihood of reporting moderate or great self-perceived risk did not vary with sexually transmitted disease history and respondent age, both strong predictors of HIV risk in the study setting. Risk perceptions were associated with stigmatising attitudes (aOR: 0.53; 95% CI: 0.26, 1.09; p = 0.09); prior HIV testing (aOR: 0.21; 95% CI: 0.13, 0.35; p < 0.01); and having heard that male circumcision is protective (aOR: 0.38; 95% CI: 0.22, 0.64; p < 0.01).ConclusionsResults indicate that HIV-risk perceptions are inaccurate. Our findings suggest that this inaccuracy stems from HIV-risk perceptions being driven by an incomplete understanding of epidemiological risk and being influenced by a range of psycho-social factors not directly related to sexual behaviour. Consequently, new interventions are needed to align perceived and actual HIV risk.

Highlights

HIV risk perceptions are a key determinant of HIV testing
The analysis restricted to HIV-negative women (Table 3, column 2) found substantively similar associations between perceived HIV risk and having had three or more lifetime partners, hearing that male circumcision reduces male HIV risk, reporting stigma on 2/3 items, knowing someone living with HIV or who had died of AIDS and having had an HIV test
In this study of young black African women in Cape Town, South Africa, we found no association between

Summary

Introduction

HIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDSfree generation – including reaching the UNAIDS 90–90-90 target – depends critically on the content of these perceptions. The Joint United Nations Programme on HIV/AIDS has outlined an ambitious blueprint to do so: ensuring that 90% of persons living with HIV/AIDS (PLWHA) know their serostatus; initiating 90% of these individuals on treatment; and achieving viral load suppression in 90% of this group [2]. Reaching these targets will require bolstering the entire cascade of HIV care, which, in turn, starts with generating demand for HIV testing services [3, 4]. No single study has systematically examined the influence of these diverse factors

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