HIV knowledge level, social support, and risk perception on attitudes toward HIV testing among heterosexuals in Indonesia

Deciding to test for HIV is necessary for receiving HIV treatment and care among those who are HIV-positive. This article presents a systematic review of quantitative studies on relationships between psychological (cognitive and affective) variables and HIV testing. Sixty two studies were included (fifty six cross sectional). Most measured lifetime testing. HIV knowledge, risk perception and stigma were the most commonly measured psychological variables. Meta-analysis was carried out on the relationships between HIV knowledge and testing, and HIV risk perception and testing. Both relationships were positive and significant, representing small effects (HIV knowledge, d = 0.22, 95 % CI 0.14–0.31, p < 0.001; HIV risk perception, OR 1.47, 95 % CI 1.26–1.67, p < 0.001). Other variables with a majority of studies showing a relationship with HIV testing included: perceived testing benefits, testing fear, perceived behavioural control/self-efficacy, knowledge of testing sites, prejudiced attitudes towards people living with HIV, and knowing someone with HIV. Research and practice implications are outlined.

Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

HIV knowledge and perceptions of risk in a young, urban, drug-using population

Objectives: In Canada, and elsewhere, Indigenous people who use illicit drugs and/or alcohol (WUID/A) experience a disproportionate burden of HIV-related harm. This study examined HIV risk perceptions and behaviours among Indigenous people WUID/A living in the Downtown Eastside (DTES) and the policies and practices that shape inequities and vulnerabilities for them in HIV testing and treatment. Further, we aimed to situate the vulnerabilities of Indigenous people WUID/A in HIV care within the context of wider structural inequality and generate recommendations for culturally relevant and safe HIV treatment options. Methods: This research employed an Indigenous-led community-based participatory approach using talking circles to explore experiences of Indigenous people living with HIV. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited participants’ experiences of HIV knowledge, testing, and treatment, and were audio-recorded and transcribed. Data were coded line-by-line and codes were organized into themes. Results: Five key themes were identified via the talking circles: evolving HIV risk perceptions (e.g., HIV knowledge and testing, and “intentional exposure”); research as an avenue for HIV testing; HIV treatment and discussions about grief and loss; HIV-related stigma and discrimination; and the importance of culturally-relevant and safe HIV treatment options for Indigenous people WUID/A. Discussion: Our work reveals that Indigenous people WUID/A do not have adequate access to HIV knowledge and education, often limiting their ability to access HIV testing and supports. Participant stories revealed both internalized and community stigma and discrimination, which at times compromised connection with participants' home communities. Further, our findings point to a failure in the public health system to deliver accessible HIV information to Indigenous Peoples, hence, many participants have solely relied on participation in community-based research studies in the Downtown Eastside (DTES) for HIV education and knowledge. There is an urgent need for accessible, culturally safe, and community-based education and treatment options for Indigenous people WUID/A within HIV care.

The aim of this study was to explore HIV knowledge, risk perception and risk behaviours, using a quantitative descriptive design. Participants included 233 randomly selected Technikon academic and non academic staff aged 19 to 65 (Mean age=40.0; SD=10.7), of which 56% were males and 44% were females, with more than two-thirds being black (70.4%). The results indicated that participants were generally knowledgeable about HIV, had low HIV risk perception and high intentions to engage in risk reducing behaviours and a sizeable minority indulged in risky behaviour. It could be concluded that there is a need for an HIV risk reduction programme aimed at strengthening HIV knowledge, preventing new infections, and increasing HIV risk perception. Key words: Border Technikon, HIV knowledge, risk perception, behavioural intentions, risk behaviour, HIV risk reduction. AJPHERD Vol.11(2) 2005: 132-148

Introduction HIV in Peru is concentrated among men who have sex with men (MSM) and transgender women (TW). Over 70% of HIV+ MSM/TW ignore their status, as HIV testing frequency is low, delaying diagnosis and treatment. We aimed to assess the relationship between HIV testing frequency and perceived HIV risk among MSM/TW. Methods This analysis included baseline data from MSM/TW who reported a negative or unknown HIV status from a STI clinic cohort of MSM/TW at high risk in Lima. The behavioural survey assessed HIV risk perception (high, moderate, low) and prior testing frequency (testing was defined as frequent if it had occurred at least biannually). For HIV diagnosis, we used a 3 rd generation rapid test, a 4 th generation EIA, and Western Blot confirmation. Chi-square tests and multivariable regression were used to estimate adjusted prevalence ratios (aPRs). Results Among eligible subjects (243 MSM and 67 TW), 122 (39%) reported frequent prior HIV testing, while HIV risk was perceived as high, moderate and low by 72 (23%), 148 (48%) and, 90 (29%) participants, respectively. Frequent HIV testing was more prevalent among participants reporting low/no HIV risk (aPR: 1.62; CI: 1.20–2.20) and among those reporting previous syphilis infection (aPR: 1.58; CI: 1.22–2.04); but was less prevalent among participants reporting recent condomless anal intercourse (aPR: 0.67; CI: 0.51–0.90). Baseline HIV status and HIV risk perception were not associated: HIV prevalence was 11%, 13% and 10% among those reporting high, moderate and low/no HIV risk (chi-square p-value >0.1). Conclusion Frequent HIV testing was more prevalent among MSM/TW reporting low/no HIV risk. Risk perception did not correlate with HIV status among previously undiagnosed subjects. WHO-recommended biannual HIV testing should be promoted, and factors potentially affecting risk perception and testing frequency (e.g. access, stigma) should be identified and addressed by HIV programming for MSM/TW in Peru.

BackgroundInterventions aimed at improving accessing of health care services, including HIV testing, remain a priority in global HIV eradication efforts. Grassroot Soccer Zimbabwe (GRSZ) is an adolescent health organisation that uses the popularity of soccer to promote healthy behaviours. We assessed HIV knowledge levels, risky behaviours and attitudes in school going adolescents and young adults who attended GRSZ programmes and determined if HIV knowledge levels were associated with increased levels of accessing of health care services by youths.MethodsThis was a cross-sectional study carried out on 450 participants aged 13–30 years who attended at least one of the three programmes offered by GRSZ. Self-administered and self-reporting questionnaires were used to collect information on participants’ demographics, knowledge on HIV and reproductive health, sources of information, access to HIV and reproductive health services and attitudes and risky behaviours.ResultsA total of 392 (87.1%) responses were received. High HIV and reproductive health knowledge levels were recorded (77.7%) on our scale with females recording higher levels (81.1%) than males (71.1%). The majority of participants (72%) indicated willingness to abstain from risky behaviours such as use of drugs and attending youth sex parties. However about 33.3% of the participants who had sexual intercourse reported having condomless sex. There was marginal association between high HIV and reproductive health knowledge levels and accessing health care services in the past 24 months (p = 0.045).ConclusionsHIV and reproductive health knowledge levels were relatively high among adolescents and were associated with accessing health care services in the past 24 months. There however are some gaps associated with engaging in risky sexual behaviours such as condomless sex which could be addressed by using these findings to assist organizations working with adolescents, educators and policy makers in developing programmes that address adolescent sexual behaviours.

Objective:To examine the relationship between HIV risk behaviour, risk perception and testing in Britain.Design:A probability sample survey of the British population.Methods:We analyzed data on sexual behaviour, self-perceived HIV risk and HIV testing (excluding testing because of blood donation) from 13 751 sexually experienced men and women aged 16–74, interviewed between 2010 and 2012 using computer-assisted face-to-face and self-interviewing.Results:Altogether, 3.5% of men and 5.4% of women reported having an HIV test in the past year. Higher perceived risk of HIV was associated with sexual risk behaviours and with HIV testing. However, the majority of those rating themselves as ‘greatly’ or ‘quite a lot’ at risk of HIV (3.4% of men, 2.5% of women) had not tested in the past year. This was also found among the groups most affected by HIV: MSM and black Africans. Within these groups, the majority reporting sexual risk behaviours did not perceive themselves as at risk and had not tested for HIV. Overall, 29.6% of men and 39.9% of women who tested for HIV in the past year could be classified as low risk across a range of measures.Conclusion:Most people who perceive themselves as at risk of HIV have not recently tested, including among MSM and black Africans. Many people tested in Britain are at low risk, reflecting current policy that aims to normalize testing. Strategies to further improve uptake of testing are needed, particularly in those at greatest risk, to further reduce undiagnosed HIV infection at late diagnoses.

BackgroundAdolescents and young adults (AYA) in the United States, and in Washington, District of Columbia (DC), specifically, are disproportionately affected by HIV. Both the national Ending the HIV Epidemic initiative and DC-specific plans emphasize HIV testing, and innovative strategies to encourage testing among AYA are needed.ObjectiveThe purpose of this study is to identify sexual behaviors, HIV knowledge, HIV perceptions (eg, susceptibility and severity), and perceived barriers and facilitators to HIV testing among AYA at risk for HIV in DC.MethodsThis study was part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA. Focus groups and surveys stratified by self-reported sexual orientation were conducted among, and administered to, AYA aged 13-24 years in DC. HIV knowledge was explored during focus groups and measured using an adapted version of the Brief HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed.ResultsOf the 46 AYA who participated in the focus groups, 30 (65%) identified as heterosexual and 16 (35%) as lesbian, gay, bisexual, transgender, or queer. A higher proportion of lesbian, gay, bisexual, transgender, or queer AYA reported sexual activity (12/16, 75%, vs 18/30, 60%), condomless sex (11/12, 92%, vs 15/18, 83%), and HIV testing (13/16, 81%, vs 17/29, 58%) than heterosexual AYA. HIV prevention (“condoms” and “...PrEP”) and transmission (“exchange of fluids”) knowledge was high, and most (34/44, 77%) of the AYA perceived HIV testing as beneficial. However, the AYA also demonstrated some misinformation concerning HIV: an average of 67% (31/46; SD 0.474) of the participants believed that an HIV test could deliver accurate results 1 week after a potential exposure and an average of 72% (33/46; SD 0.455) believed that an HIV vaccine exists. The AYA also identified individual (“...people...are scared”), interpersonal (“it’s an awkward conversation”), and structural (“...people don’t...know where they can go”) barriers to testing. Most of the AYA indicated that they were very likely to use the demonstrated game prototype to help with getting tested for HIV (median 3.0, IQR 2.0-3.0, using a scale ranging from 0 to 3, with 3 indicating high likelihood) and strongly agreed that the game was interesting (median 5.0, IQR 5.0-5.0), fun (median 5.0, IQR 4.0-5.0), and easy to learn (median 5.0, IQR 5.0-5.0, using a scale ranging from 1 to 5, with 5 indicating strong agreement).ConclusionsThese results suggest a need for multilevel HIV testing interventions and informed the development of a mobile health intervention aiming to increase HIV knowledge and risk perception among AYA, while reducing barriers to testing at the individual and structural levels, supporting efforts to end the domestic HIV epidemic.

Little is known about HIV testing, pre-exposure prophylaxis (PrEP) awareness and uptake among adolescent and young men who have sex with men (AYMSM) in Vietnam. We conducted an online survey among AYMSM in Vietnam to determine the prevalence of HIV testing, PrEP awareness, uptake and their correlates. From December 2022-March 2023, 120 HIV-negative AYMSM from 15 to 19 years old in Hanoi and Ho Chi Minh city, Vietnam were recruited through peer referral to complete an online survey, which included questions on demographics, sexual behaviors, HIV risk perception and knowledge, HIV and sexually transmitted infections (STI) testing, PrEP awareness and uptake. Separate multivariable models were used to determine the correlates of HIV testing, PrEP awareness and uptake. Only 58% of participants had ever been tested for HIV. The majority of participants had heard of PrEP before (82%), but only 36% had ever used PrEP. HIV knowledge (aPR (adjusted prevalence ratio) = 1.59; 95%CI:1.06-2.39), a history of STI testing (aPR = 1.32; 95%CI:1.06-1.64), having had anal sex with another man (aPR = 4.49; 95%CI:1.40-14.38) and lower HIV risk perception (aPR = 0.62; 95%CI:0.47-0.83) were associated with HIV testing. HIV knowledge (aPR = 1.38; 95%CI:1.06-1.78) and a history of STI testing (aPR = 1.16; 95%CI:1.03-1.32) were also associated with PrEP awareness. Higher HIV risk perception was negatively associated with PrEP use (aPR = 0.59; 95%CI:0.35-0.99). Our findings underscored the urgent need for further research to explore the causes of the gaps in HIV testing and PrEP use as well as to design innovative interventions tailored to the needs of AYMSM to support HIV testing and PrEP use.

An Exploration of Men's Knowledge, Attitudes, and Perceptions of HIV, HIV Risk, and Willingness to Test for HIV in Yendi District, Northern Ghana

Theoretical models suggest that both HIV knowledge and HIV risk perception inform rational decision making and, thus, predict safer sex motivation and behavior. However, the amount of variance explained by knowledge and risk perception is typically small. In this cross-sectional study, we investigated whether the predictive power of HIV knowledge and HIV risk perception on safer sex motivation is affected by trait anger. We hypothesized that anger may disrupt rational decision making, distorting the effects of both HIV knowledge and risk perception on safer sex intentions. Data from 232 low-income, urban women at risk for HIV infection were used to test a path model with past sexual risk behavior, HIV knowledge, and HIV risk perception as predictors of safer sex intentions. Moderator effects of anger on safer sex intentions were tested by simultaneous group comparisons between high-anger and low-anger women (median split). The theoretically expected "rational pattern" was found among low-anger women only, including (a) a positive effect of knowledge on safer sex intentions, and (b) buffer (inhibitor) effects of HIV knowledge and HIV risk perception on the negative path leading from past risk behavior to safer sex intentions. Among high-anger women, an "irrational pattern" emerged, with no effects of HIV knowledge and negative effects of both past risk behavior and HIV risk perception on safer sex intentions. In sum, the results suggest that rational knowledge- and risk-based decisions regarding safer sex may be limited to low-anger women.

Colombia has experienced a significant increase in the incidence of HIV in the past decade attributed to the alarming rise of heroin injection. However, there is limited information about the level of HIV knowledge and the perception of risk among people who inject drugs (PWIDs) in Latin America. Further data is needed to optimally inform HIV prevention efforts in the region. The present study explores the level of HIV knowledge and risk perception, and their potential association with risk practices among PWIDs in Colombia. The survey instrument included the 18-item HIV Knowledge Questionnaire and the Risk Assessment Battery. Among the 190 respondents who completed the survey, approximately half demonstrated a limited knowledge of HIV (51.1%, n = 97). Misconceptions regarding the mechanisms of HIV transmission and the usefulness of female condoms were common. Homelessness was associated with limited HIV knowledge (p = .006, OR 2.62 IC 95% 1.31–5.25). Lastly, HIV knowledge was associated with safer injection behaviors, but was not related to safe sexual practices. Perceived risk of HIV exposure was not related to the level of HIV knowledge, drug-related, or sexual risk behaviors. Overall, our results indicate that misconceptions about the mechanisms of HIV transmission persist among PWIDs in Colombia, particularly among unstably housed respondents. Further efforts are needed to address social determinants of health, including housing access, among this vulnerable population to reduce the risks of HIV exposure.

Men who have sex with men (MSM) may prioritize interpersonal and structuralfactors, such as LGBTQ-related inequalities, housing instability, financialinsecurity, and relationship seeking, over HIV prevention. The aim of this studywas to assess how MSM prioritize HIV relative to other factors and theassociation between HIV prioritization, HIV testing and sexual risk behavior,and perceived risk. Data were collected from a national online survey of MSM inthe United States assessing HIV knowledge and prioritization. Participantsranked HIV prevention relative to LGBTQ-related concerns and life issues (e.g.,housing, job, relationship). Adjusted regression models were conducted to assessthe association of HIV prioritization with HIV testing and condomless anal sex(CAS) and to evaluate associations between perceived risk and HIV risk behavior.Among 516 participants, HIV prevention was ranked significantly higher among MSMreporting recent CAS (p = .04) and HIV testing within the past(p = .02); HIV prevention was prioritized higher relativeto life issues among MSM reporting last HIV test more than 1 year ago(p = .02). Perceived HIV risk was significantly associatedwith higher HIV prioritization relative to LGBTQ concerns (p =.001) and life issues (p = .001). Higher HIV perceived risk wasassociated with lower odds of any CAS (p < .001) and higherodds of having an HIV test in the past year (p < .001). Inthis online study, HIV prioritization was identified as differentiallyassociated with HIV testing, sexual risk behavior, and perceived HIV risk. HIVprevention programs should integrate strategies to address social and structuralinequalities based on priority needs of MSM.

The aim of this study is to investigate HIV knowledge, beliefs and HIV risk behaviours among ex-offenders in Mpumalanga province, South Africa. A sample of 85 male ex-offenders conveniently selected from an exoffenders organization were interviewed with a structured and open-ended questionnaire. Results indicate good overall HIV knowledge but also significant misconceptions such as 45.9% believed that many sexual partners are needed to get HIV, 31.8% that there is a cure for AIDS and 25.9% believed that a pregnant woman cannot give HIV to their baby. The personal risk of getting HIV was rated as relatively low, with 8.2% already HIV infected. Almost all ex-offenders (91.2%) had been sexually active in the past 12 months. Various HIV risk behaviours were found, almost one in 5 had multiple sex partners, one in ten commercial sex and almost half lacked condom use and 56.5% had never had an HIV test. Linear regression analyses between HIV risk variables and HIV risk behaviour index controlled by demographic variables found no significant predictors. The study revealed that ex-offenders have high rates of unprotected sex, and limited exposure to effective HIV education and prevention interventions. Community organizations dealing with ex- offenders need to improve HIV training for officers working with exoffenders so that they can impart this knowledge to exoffenders and make HIV risk reduction programmes more available to ex- offenders.Key words: HIV knowledge, HIV risk, HIV risk behaviour, ex-offenders, South Africa