The Rhythm of Risk: Sexual Behaviour, PrEP Use and HIV Risk Perception Between 1999 and 2018 Among Men Who Have Sex with Men in Amsterdam, The Netherlands

Maartje Basten,Mirjam Kretzschmar,Janneke C M Heijne,Udi Davidovich,Anders Boyd,Chantal Den Daas,Ganna Rozhnova,Amy Matser

doi:10.1007/s10461-020-03109-4

Abstract

HIV risk perception plays a crucial role in the uptake of preventive strategies. We investigated how risk perception and its determinants changed between 1999 and 2018 in an open, prospective cohort of 1323 HIV-negative men who have sex with men (MSM). Risk perception, defined as the perceived likelihood of acquiring HIV in the past 6 months, changed over time: being relatively lower in 2008–2011, higher in 2012–2016, and again lower in 2017–2018. Irrespective of calendar year, condomless anal intercourse (AI) with casual partners and high numbers of partners were associated with higher risk perception. In 2017–2018, condomless receptive AI with a partner living with HIV was no longer associated with risk perception, while PrEP use and condomless AI with a steady partner were associated with lower risk perception. We showed that risk perception has fluctuated among MSM in the past 20 years. The Undetectable equals Untransmittable statement and PrEP coincided with lower perceived risk.

Highlights

Current HIV risk reduction strategies include condom use, maintaining undetectable viral load, regular HIV testing, and use of pre-exposure prophylaxis (PrEP)
Among men who have sex with men (MSM) participating in the Amsterdam Cohort Studies (ACS), we found that perceived risk of HIV has fluctuated at the population level in the past 20 years
Based on relative differences in risk perception between waves and the overall grand mean, we distinguished five alternating periods of relatively low and high perceived risk of HIV. Throughout these time periods, increasing number of receptive and insertive anal intercourse (AI) partners and having condomless AI with casual partners were consistently associated with higher risk perception

Summary

Introduction

Current HIV risk reduction strategies include condom use, maintaining undetectable viral load (for individuals living with HIV), regular HIV testing, and use of pre-exposure prophylaxis (PrEP). Unrealistically low risk perception was found to be an important barrier for successful PrEP implementation [7] and HIV testing [8, 9], and was one of the main reasons why patients with late HIV diagnosis did not get tested earlier [10]. These studies show that in order for MSM to take preventive measures, a realistic perception of HIV risk is crucial. To improve uptake of preventive strategies, further understanding is needed as to what factors influence risk perception

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