Abstract
Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32–37) and 34% (95% CI: 32–36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52–53) for those ≥ 15 years old and 48% (95% CI: 48–49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.
Highlights
Tremendous resources have been invested to educate populations in regions of high HIV prevalence, such as South Africa, about HIV risk and prevention
The population of interest in this study was the subset of HAALSI participants who had responded to at least one of the four questions of interest
Of the 3836 (89.7%) participants who consented to Dried bloodspots (DBS) HIV testing, 2948 (76.9%) tested negative, while 888 (23.1%) tested positive for HIV (Table 1)
Summary
Tremendous resources have been invested to educate populations in regions of high HIV prevalence, such as South Africa, about HIV risk and prevention. In order to prevent HIV in high-risk populations, it is critically important to understand current perceptions of HIV and potential knowledge deficits among people living in areas of high prevalence and design interventions to fill. Accurate risk perception may promote protective behavior, and underestimation of risk may lead to more risky behavior (Brewer et al, 2004; Kalichman & Cain, 2005). It is important that individuals have accurate perceptions about HIV acquisition risk and prevalence. Perceptions of risk of acquisition and prevalence of HIV among heterosexual partners are unknown in many regions of high HIV prevalence, including South Africa
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