Abstract
Risk perception for HIV infection is an important determinant for engaging in HIV prevention behaviour. We investigate the degree to which HIV risk perception is accurate, i.e. corresponds to actual HIV infection risks, in a general-population open-cohort study in Zimbabwe (2003–2013) including 7201 individuals over 31,326 person-years. Risk perception for future infection (no/yes) at the beginning of periods between two surveys was associated with increased risk of HIV infection (Cox regression hazard ratio = 1.38 [1.07–1.79], adjusting for socio-demographic characteristics, sexual behaviour, and partner behaviour). The association was stronger among older people (25+ years). This suggests that HIV risk perception can be accurate but the higher HIV incidence (1.27 per 100 person-years) illustrates that individuals may face barriers to HIV prevention behaviour even when they perceive their risks. Gaps in risk perception are underlined by the high incidence among those not perceiving a risk (0.96%), low risk perception even among those reporting potentially risky sexual behaviour, and, particularly, lack of accuracy of risk perception among young people. Innovative interventions are needed to improve accuracy of risk perception but barriers to HIV prevention behaviours need to be addressed too, which may relate to the partner, community, or structural factors.
Highlights
HIV incidence remains high in many countries, in sub-Saharan Africa, with reductions failing to meet international targets [1]
Among males (N = 3553), 13.0% (95% confidence interval [confidence intervals (CI)] = 11.9–14.1%) perceived a risk of HIV infection, and 47.5% (46.4–48.7%) among females (N = 7221), with declines over time observed for both sexes (Fig. 1a)
Risk perception was higher in those with sexual risk factors and in those reporting that their partners had other partners
Summary
HIV incidence remains high in many countries, in sub-Saharan Africa, with reductions failing to meet international targets [1]. In part, this reflects continued low use of primary HIV prevention methods, including condoms, voluntary medical male circumcision (VMMC), and preexposure prophylaxis (PrEP) [2]. HIV infection risk varies considerably across areas [12, 13] and within populations, with some groups, for example adolescent girls and young women [14], exhibiting disproportionally high HIV incidence. It is vital that those with increased HIV infection risk perceive their risk and engage in protective. While “unrealistic optimism”—underestimating one’s risk—has been demonstrated for HIV infection risk [16,17,18], evidence for a match between self-perceived and actual HIV infection risk is limited—despite the importance widely attached to HIV risk perception
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