Higher Self-perceived Risk Research Articles

Self-perception of risk for HIV acquisition among people in prisons in Iran: A nationwide survey in 2017

BackgroundSelf-perception of risk for HIV acquisition is crucial for promoting preventive behaviors among people in prisons. This cross-sectional study examined self-perception of HIV risk and associated factors among people in prisons in Iran.MethodsIn 2017, we conducted a cross-sectional study in Iran using multistage random sampling approach to recruit participants from 33 prisons in Iran. Eligible participants were adult people in prisons for at least one week. Data were collected via gender-matched face-to-face interviews using a standard HIV risk assessment questionnaire. Multivariable logistic regression models were built to identify correlates of high self-perceived HIV risk. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported.ResultsAmong 5,422 HIV-negative participants (94.0% men; mean age 35.7 years), 6.8% (95% CI: 6.1–7.5%) reported high self-perception of risk for HIV acquisition. Among these, 3.6%, 5.2%, and 8.4% reported zero, one, and more than one risky behavior, respectively. Higher odds of high self-perceived risk were associated with being < 30 years old (AOR: 1.50; 95% CI: 1.13–2.00), having never got married (AOR: 1.58; 95% CI: 1.12–2.23), engaging in condomless sex (AOR: 1.56; 95% CI: 1.13–2.16), same-sex practices among men (AOR: 1.90; 95% CI: 1.43–2.51), and recent sexually transmitted infection symptoms (AOR: 2.18; 95% CI: 1.19–3.57).ConclusionsA notable gap exists between actual HIV risk behaviors and self-perceived risk among people in prisons in Iran. Targeted prison-based educational interventions are essential to improve risk awareness and promote HIV prevention behaviors among this marginalized population.

Knowledge, Attitudes, and Utilization of HIV PrEP among Black College Students in the United States: A Systematic Review

Considering the diverse socio-cultural norms, sexual attitudes, and mental and emotional immaturity that generally exist among young adults, Black college students are behaviorally vulnerable to acquiring new HIV infections before requisite exposure to HIV prevention education. Black college students (aged 18 to 34) fall within the description of one of the highest priority populations at risk for new HIV infection given the overall under-utilization and racial disparities in the HIV pre-exposure prophylaxis (PrEP) coverage among Black people in the United States (U.S). Yet, research addressing sexuality and HIV PrEP amongst Black college students are limited. This systematic review undertakes a comprehensive exploratory search of eight databases and includes four studies that have been conducted regarding Black college students HIV PrEP knowledge, attitudes and PrEP utilization in the U.S. Our findings suggest a high rate of sexual activity and hesitancy to initiate PrEP due to fear, exacerbated by low comprehensive knowledge of PrEP, low self-perceived HIV risk, and low HIV testing before any PrEP educational intervention. Positive PrEP utilization was closely associated with high self-perceived HIV risk following PrEP education, particularly when individual and structural factors were satisfactorily addressed. Current evidence suggests that PrEP is grossly under-utilized by Black college students who may benefit from it, and attitudes are driven by multiple determinants informed by psycho-social and structural barriers to PrEP access or acceptability in the U.S. Therefore, PrEP education is a potent tool for improving sexual health behaviour and attitude among Black college students.

Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members With Newly Diagnosed HIV Infection.

There have been nearly 1,600 new diagnoses of Human Immunodeficiency Virus (HIV) across the US Armed Forces between 2017 and 2022. While treatment has improved overall survival, self-perception of acquiring HIV may not align with actual risk of acquiring HIV, thus slowing diagnosis and treatment. We aim to evaluate self-perceived risk (SPR) versus calculated risk (CR) of HIV infection in US Air Force (USAF) members with incident HIV diagnosis. All USAF members with new HIV diagnosis evaluated at a specialty care military medical center between January 2015 and March 2020 with case report forms were included (n = 142). SPR was compared to CR using the Denver HIV Risk Score (DHRS). The study was approved by the Army Public Health Center's Public Health Review Board (#14-311) and the Walter Reed Army Institute of Research Human Subjects Protection Branch (#1861E). Patients were predominantly male (98%), with a median age of 26 (IQR 22-30) years, and the majority (85%) reported same-sex partners. Most patients reported a low SPR (n = 78; 55%). A higher proportion of low SPR patients were married or partnered than high SPR patients (29% versus 14%; P = 0.04). Both groups had median DHRS scores in the highest risk category with similar results by reason for HIV screening. The majority of USAF members with incident HIV infection reported a low SPR despite risk factors and CRs identical to high SPR patients. In order to inform HIV prevention strategies in the military, further efforts are needed to educate the military population and providers about HIV risk perception.

Associations Between Risk Perception and HPV Knowledge and Vaccine Uptake: Highlighting the LGBTQ+ Population.

Gay and bisexual males and other LGBTQ+ communities are more frequently exposed to factors associated with an increased risk of human papillomavirus (HPV) acquisition. Vaccination is critical to protect against HPV+ head and neck cancer (HNC). We characterized the association of perceived level of risk of contraction with HPV knowledge, and vaccine decision-making. Cross-sectional cohort. LGBTQ and general survey Reddit forums (control). A survey was shared amongst the online forums. Descriptive statistics characterized the data. Multivariable logistic regression was used to understand factors associated with vaccination, self-perceived high risk, and knowledge of HPV + HNC. Of 718 respondents, most were female (41.09%), Caucasian (59.89%), college-educated (33.01%), and insured (77.15%) with a mean age of 30.75 years. Half were vaccinated (49.16%), with most unvaccinated endorsing interest (60.58%). Few dependents were vaccinated (25.91%), with interest in vaccination among parents of unvaccinated children (38.58%). Knowledge of HIV's association with HPV (62.95%), HPV causing HNC (55.57%), and the vaccine's efficacy against HNC (55.57%) was also moderate. Identifying female (P = .042), a self-perceived high-risk (P < .001), and having vaccinated children (P < .001) increased vaccination likelihood; transgender (P = .021), or lesbian or gay sexual identity (P < .001) decreased likelihood. Personal HNC diagnosis (P < .001), self-vaccination (P < .001), having vaccinated children (P < .001), having anal sex (P = .001) or no knowledge of past HPV status (P < .001) increased likelihood of high self-perceived risk. Efforts to improve public education regarding the association between HPV and HNC and vaccination efficacy are required to better inform vaccine decision-making among individuals at risk for HPV infection.

Self-Perception of HIV Risk and Interest in Pre-Exposure Prophylaxis in a General Obstetrics and Gynecology Clinic Population.

Background: Pre-exposure prophylaxis (PrEP) for HIV is underutilized, particularly among attendees of obstetrics and gynecology (Ob/Gyn) clinics. Lack of self-perception of HIV risk is a barrier to PrEP utilization, and a lack of understanding of community risk factors for HIV may contribute to that lack of self-perception of risk. Methods: Attendees of general Ob/Gyn clinics in New Orleans completed a survey assessing HIV knowledge, self-perception of HIV risk, and interest in PrEP. They reviewed a brief written educational intervention on demographic and behavioral risk factors for HIV and availability of PrEP. HIV knowledge, self-perception of HIV risk, and interest in PrEP were reassessed after the intervention. Results: One-hundred seventy individuals completed the survey. Eighty-five participants (50%) expressed initial interest in PrEP. Self-perception of risk of HIV acquisition was associated with interest in PrEP. Ten of 11 (90.9%) respondents who had high self-perceived risk of HIV were interested in PrEP, compared with 75 of 159 (47.2%) of those who had low self-perceived risk (p = 0.01). The association remained significant in a multivariate analysis. After the intervention, the number of those who perceived themselves to be at risk of HIV increased from 11 to 25 individuals (p < 0.01) and 20 of these (80%) were interested in PrEP. Knowledge of HIV risk factors increased (p < 0.01). The intervention did not significantly alter interest in PrEP. Conclusions: Self-perception of HIV risk was associated with interest in PrEP. A brief written educational intervention increased knowledge of HIV risk factors and increased self-perception of risk of HIV. The intervention did not translate to increased interest in PrEP.

Risk Perception About HIV Among University Students in One of the Last Hotspots for HIV Transmission in Europe

BackgroundHIV testing in the Northern Kosovo province is challenging, because the infrastructure is being rebuilt after the ethnic conflict. The purpose of this research was to examine self-perceived risk for acquiring HIV infection and factors associated with risk assessment among university students.MethodsStudents completed a questionnaire on socio-demographic data, knowledge about HIV prevention and transmission, attitudes toward people living with (PLHIV) and self-perceived risk for HIV infection. The self-perceived risk was categorized as low, unknown and high.ResultsThe majority of students (72.5%) assessed their risk as low, 8.5% assessed their risk as high and 19.1% did not know their risk. Compared to low self-perceived risk, high self-perceived HIV risk was associated with being male, having lower knowledge about HIV prevention, less strong Segregation and protection attitude toward PLHIV, stronger Ignorance and indifference attitude toward PLHIV and positive opinion about gays/lesbians. Students who perceived own risk for acquiring HIV as high had lower knowledge about HIV transmission and prevention. However, those who were previously tested for HIV, despite their poorer knowledge about HIV prevention, assess their HIV-related risk as low.ConclusionsStudents assessed their risk of HIV infection mostly as low. Still, lower knowledge of HIV prevention has been consistently associated with a high and unknown risk of HIV. Moreover, being ignorant and indifferent about PLHIV was associated with increased self-perceived HIV risk. These findings highlight the need for continuous specialized HIV-related education to reduce fear and stigma of PLHIV and HIV testing as well as risky behaviors.

Profiles of People Who Carried Out Late Primary Vaccination against COVID-19 in the Region of Murcia.

Despite the impact of the COVID-19 vaccination, vaccine hesitancy is a matter of concern. Despite a lower disease incidence, people continue to start primo-vaccination late. The aim of this study is to characterize people late primo-vaccinated and the reasons that led them to start vaccination. A quantitative, descriptive and prospective study was performed on the basis of phone surveys of people vaccinated from February to May 2022 in the Region of Murcia (Spain). The survey included socio-demographic and COVID-19 information, self-perception risk, vaccine security, Fear of COVID-19 Scale, reasons for not being vaccinated and reasons that have led them to vaccination. From a total of 1768 people receiving primo-vaccination, 798 people were contacted, and 338 people completed the survey. Among the interviewed people, 57% reported non-health-related reasons to get vaccinated, travel reasons being the primary one. The most reported health-related reason was a fear of COVID-19. There was a significant positive association between vaccination for health-related reasons and female gender (β = 0.72), cohabiting with a vulnerable person (β = 0.97), higher self-perceived risk (β = 0.13) and vaccine security dimension (β = 0.14). We identified two different profiles of people with late COVID-19 primo-vaccination, with health-related or non-health-related reasons. This work can be useful in designing specific communication strategies.

Providing HIV pre-exposure prophylaxis to men who have sex with men and transgender women in hospitals and community-led clinics in Thailand: acceptance, patterns of use, trends in risk behaviors, and HIV incidence

ABSTRACT From May 2015 to June 2018, we conducted a PrEP demonstration project at two hospitals and four community-led clinics in Bangkok and Pattaya. HIV-negative, MSM and TGW aged ≥18 years old, reporting sex without a condom, were offered daily PrEP. Participants received HIV testing and completed a computer-based questionnaire at enrollment, 6 and 12 months. We collected self-reported PrEP adherence at months 1, 3, 6, 9, and 12. We used logistic regression to determine factors associated with the decision to take PrEP and calculated HIV incidence among baseline HIV-negative participants. Of 803 participants enrolled, 349 (43.5%) started PrEP. Participants were more likely to start PrEP if they were sex workers, had moderate or high self-perceived risk of HIV, or a high PrEP-knowledge score. Participants used PrEP for a median of 6.1 months. Reported condom use increased and the number of sex partners decreased during follow-up regardless of PrEP use. Six participants not-taking PrEP acquired HIV (HIV incidence 2.2 per 100 person-years), and five taking PrEP acquired HIV (HIV incidence 2.1 per 100 person-years). All five reported taking <4 pills the weeks before study visits.

Assessing the Underestimation of HIV Risk Infection among Young Men Who Have Sex with Men in Argentina.

The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5-11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161-121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1-3.5]) and using LSD (aOR = 5.44 [CI 95:1.32-30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.

54. Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members with Newly Diagnosed HIV Infection

BackgroundPersons may underestimate their risk of HIV infection despite presence of risk factors. Accurate appraisal of HIV risk may assist both patients and providers in preventing HIV acquisition. We evaluated self-perceived risk (SPR) versus calculated risk (CR) of HIV infection in active duty US Air Force (USAF) members with incident HIV infection.MethodsUSAF members with new HIV diagnosis evaluated at a specialty care military medical center between January 2015-March 2020 with available case report forms were included (n=142). Chart reviews were performed and demographic, social, and clinical characteristics were collected from initial Infectious Disease specialty encounters and case report forms. SPR was characterized as Low or High and compared to CR derived by the Denver HIV Risk Score (DHRS) by points based on patient demographic and risk exposure characteristics.ResultsOverall, patients were predominantly male (98%), with a median age of 26 years (IQR 22-30), and the majority (85%) reported same-sex partners (Table 1). Patients more commonly characterized themselves as Low SPR (n=78; 55%) than High SPR (n=64; 45%). Demographic characteristics were similar except a higher proportion of Low SPR patients (29%) were married or partnered compared to High SPR patients (14%; p=0.04). There was no difference in self-reported condom use (≥50% of the time) between Low (63%) and High (72%) SPR patients (p=0.28) and documented history of sexually transmitted infections was similarly high in both groups ( >70%; p=0.85). Previous HIV pre-exposure prophylaxis (PrEP) use was uncommon in both Low SPR (8%) and High SPR (6%) groups. For the evaluation of CR by DHRS (Table 2), both Low and High SPR groups had median scores in the very high risk category (≥50 points) with similar results by test component. ConclusionUSAF members with incident HIV infection more commonly identified with low SPR despite similar risk behaviors and CRs as high SPR patients. The development of patient education programs and promotion of HIV prevention services including PrEP are needed to reduce incident HIV cases in the USAF. Validated HIV risk calculators like the DHRS may also assist medical providers in identifying candidates for HIV prevention services.Disclosures All Authors: No reported disclosures

Low SARS-CoV-2 seroprevalence but high perception of risk among healthcare workers at children\u2019s hospital before second pandemic wave in Germany

BackgroundHealthcare workers are considered a particularly high-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Healthcare workers in paediatrics are a unique subgroup: they come into frequent contact with children, who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, therefore, may transmit the disease to unprotected staff. In Germany, no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions.MethodsWe tested the staff at a large children’s hospital in Germany for immunoglobulin (Ig) G antibodies against the nucleocapsid protein of SARS-CoV-2 in a period between the first and second epidemic wave in Germany. We used a questionnaire to assess each individual’s exposure risk and his/her own perception of having already been infected with SARS-CoV-2.ResultsWe recruited 619 participants from all sectors, clinical and non-clinical, constituting 70% of the entire staff. The seroprevalence of SARS-CoV-2 antibodies was 0.325% (95% confidence interval 0.039–1.168). Self-perceived risk of a previous SARS-CoV-2 infection decreased with age (odds ratio, 0.81; 95% confidence interval, 0.70–0.93). Having experienced symptoms more than doubled the odds of a high self-perceived risk (odds ratio, 2.18; 95% confidence interval, 1.59–3.00). There was no significant difference in self-perceived risk between men and women.ConclusionsSeroprevalence was low among healthcare workers at a large children’s hospital in Germany before the second epidemic wave, and it was far from a level that confers herd immunity. Self-perceived risk of infection is often overestimated.

Preparedness for self-isolation or quarantine and lockdown in South Africa: results from a rapid online survey

BackgroundThe World Health Organization (WHO) declared the COVID-19 pandemic a public health emergency of international concern. South Africa, like many other countries, initiated a multifaceted national response to the pandemic. Self-isolation and quarantine are essential components of the public health response in the country. This paper examined perceptions and preparedness for self-isolation or quarantine during the initial phase of the pandemic in South Africa.MethodsThe analysis used data obtained from an online quantitative survey conducted in all nine provinces using a data-free platform. Descriptive statistics and multivariable logistic regression models were used to analyse the data.ResultsOf 55,823 respondents, 40.1% reported that they may end up in self-isolation or quarantine, 32.6% did not think that they would and 27.4% were unsure. Preparedness for self-isolation or quarantine was 59.0% for self, 53.8% for child and 59.9% for elderly. The odds of perceived possibility for self-isolation or quarantine were significantly higher among Coloureds, Whites, and Indians/Asians than Black Africans, and among those with moderate or high self-perceived risk of contracting COVID-19 than those with low risk perception. The odds were significantly lower among older age groups than those aged 18–29 years, and those unemployed than fully employed. The odds of preparedness for self-isolation or quarantine were significantly less likely among females than males. Preparedness for self, child and elderly isolation or quarantine was significantly more likely among other population groups than Black Africans and among older age groups than those aged 18–29 years. Preparedness for self, child and elderly isolation or quarantine was significantly less likely among those self-employed than fully employed and those residing in informal dwellings than formal dwellings. In addition, preparedness for self-isolation or quarantine was significantly less likely among those with moderate and high self-perceived risk of contracting COVID-19 than low risk perception.ConclusionThe findings highlight the challenge of implementing self-isolation or quarantine in a country with different and unique social contexts. There is a need for public awareness regarding the importance of self-isolation or quarantine as well as counter measures against contextual factors inhibiting this intervention, especially in impoverished communities.

1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic

BackgroundPre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described.MethodsWe identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH).ResultsUp to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP.ConclusionReasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care.Disclosures All authors: No reported disclosures.

Current US Guidelines for Prescribing HIV Pre-exposure Prophylaxis (PrEP) Disqualify Many Women Who Are at Risk and Motivated to Use PrEP.

US Centers for Disease Control and Prevention clinical guidelines for HIV pre-exposure prophylaxis (PrEP) are widely used to assess patients' PrEP eligibility. The guidelines include 2 versions of criteria-guidance summary criteria and recommended indications criteria-that diverge in a potentially critical way for heterosexually active women: Both require women's knowledge of their own risk behavior, but the recommended indications also require women's knowledge of their partners' HIV risk or recognition of a potentially asymptomatic sexually transmitted infection. This study examined women's PrEP eligibility according to these 2 different versions of criteria across risk and motivation categories. HIV-negative women (n = 679) recently engaged in care at Connecticut Planned Parenthood centers were surveyed online in 2017. The survey assessed PrEP eligibility by both versions of Centers for Disease Control and Prevention criteria, HIV risk indicators, PrEP motivation indicators, and sociodemographic characteristics. Participants were mostly non-Hispanic white (33.9%) or black (35.8%) and had low income (<$30,000/year; 58.3%). Overall, 82.3% were eligible for PrEP by guidance summary criteria vs. 1.5% by recommended indications criteria. Women disqualified by recommended indications criteria included those reporting condomless sex with HIV-positive or serostatus-unknown male partners (n = 27, 11.1% eligible); 1 or more recent sexually transmitted infection(s) (n = 53, 3.8% eligible); multiple sex partners (n = 168, 3.0% eligible); intended PrEP use (n = 211, 2.8% eligible); and high self-perceived risk (n = 5, 0.0% eligible). Current guidelines disqualify many women who could benefit from PrEP and may lead to discrepant assessments of eligibility. Guideline reform is needed to improve clarity and increase women's PrEP access and consequent HIV protection.

Barriers to HIV pre-exposure prophylaxis among African, Caribbean and Black men in Toronto, Canada.

IntroductionSingle-tablet combination emtricitabine/tenofovir is highly effective as HIV pre-exposure prophylaxis (PrEP). Scale-up efforts have targeted men who have sex with men (MSM), but patterns of racial disparities in PrEP use have begun to emerge. African, Caribbean and Black (ACB) communities in Canada and USA are also disproportionately affected by HIV, and there is lack of guidance regarding PrEP implementation in this priority population.MethodsACB men from Toronto, Canada were recruited in community settings by peers. Participants completed a detailed socio-behavioural questionnaire. Biological samples were collected and tested for sexually transmitted infections. Willingness to accept PrEP was assessed in relation to actual and self-perceived risk of acquiring HIV, as well as demographic and behavioural variables.Results424 ACB men were included in the analysis. ACB MSM were more likely to accept PrEP than ACB men only reporting sex with women (MSW; 50.0% vs. 23.6%). The most common reasons for PrEP non-acceptance were concerns regarding side-effects and low self-perceived risk. PrEP acceptance was lowest among younger men (12.5%) and those born in Canada (15.2%). Men with a high self-perceived HIV risk were more likely to accept PrEP (41.3% vs. 22.7% of men with a low self-perceived risk), but only 25.4% of men who were defined as being at high-risk, self-identified themselves as such.ConclusionsMost ACB MSW were unlikely to accept PrEP, largely due to low self-perceived HIV risk, but PrEP acceptance among ACB MSM was similar to other contemporaneous Toronto MSM communities. PrEP acceptance was particularly low among younger ACB men and those born in Canada. Tailored strategies will be needed to effectively implement PrEP in Toronto ACB communities.

Community awareness of, use of and attitudes towards HIV pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: preparing health promotion for a publicly funded PrEP program.

Adult MSM were recruited from January to June 2017 through a local community-based organisation's PrEP campaign website (www.getpreped.ca). Participants self-completed an anonymous online questionnaire, and were stratified into three groups: (i) HIV-positive participants; (ii) HIV-negative participants not using PrEP; and (iii) HIV-negative participants using PrEP. Descriptive, bivariate and univariate regression analyses were conducted. Of 249 participants, 191 (77%) were HIV-negative not using PrEP, 41 (17%) were HIV-negative using PrEP and 17 (7%) were HIV-positive. Among PrEP users, 90% used PrEP daily and all reported having recommended medical follow-up care. Among HIV-negative, non-PrEP-users, 44% said they would reduce condom use if they used PrEP and 28% were uncomfortable asking their doctor for PrEP. Interest in PrEP among non-users was associated with higher objective risk scores (i.e. HIV Incidence Risk Index for MSM), higher self-perceived risk, greater perceived PrEP effectiveness, no prescription medications insurance, open or single relationship status (vs closed) and not always using condoms (vs always). Among HIV-positive participants, 53% agreed PrEP reduced stigma for people living with HIV. All study groups perceived a greater percentage of MSM on PrEP (10%, 15%, 18%) than in their own social networks (5%, 4%, 6%). PrEP health promotion must consider comprehensive PrEP education; accuracy of self-perceived HIV risk and PrEP social norms; and barriers to culturally safe primary care for MSM.

103 Impact of Self-Perceived Risk and Trust in the Emergency Physician on Outpatient Follow-Up in Low-Risk Chest Pain Patients Discharged From the Emergency Department

It is appropriate to discharge patients who present to the emergency department (ED) with symptoms consistent with acute coronary syndrome (ACS) with close outpatient follow-up if they are deemed to be low-risk. Patient compliance with follow-up in this population remains a challenge; little is understood about barriers to follow-up beyond associated demographic and social factors. We hypothesize that a patient’s perception of their risk for cardiac disease and their trust in the emergency physician at the time of discharge impact compliance with follow-up in a low-risk for ACS chest pain population. This is a prospective study of patients who presented to a large urban ED with chest pain who were discharged with a scheduled follow-up appointment at an acute response clinic (ARC). ARC appointments are provided to patients regardless of insurance status. All data was collected by in-person surveys administered prior to discharge from the emergency department. Subjects provided demographic information, completed the Short Assessment of Health Literacy (SAHL-E), the Trust in Physician Scale (TiPS), estimated their risk for heart disease, and were asked to report barriers to follow-up. Patients were followed via the electronic medical record to assess whether they attended their ARC appointment. Descriptive statistics were used to calculate differences. 70 patients were enrolled in this study. The average age of the cohort is 48.8 years and it is comprised of 54.3% women with an overall follow-up rate of 42.9%. Five patients cancelled their ARC appointments; 4 of these 5 patients achieved follow-up with an outside clinic, 1 patient was lost to follow-up. Patients who reported low self-perceived risk of heart disease, less than 10%, were less likely to show for their follow-up appointment than those reporting high self-perceived risk, between 10-99% (19% versus 46%, p<0.05). Seven patients reported 100% risk and were excluded from significance testing as they already carried a diagnosis of heart disease. Additionally, low-trust in the emergency physician was associated with a higher follow-up rate as compared with medium and high-trust in the physician (52% versus 27.5%, p<0.05). Sex, age, employment, and insurance status were not associated with follow-up rate. 60% of patients reported having barriers to follow-up; transportation was the most commonly noted barrier (58.9%). Patients who reported barriers to follow-up and patients who screened positive for low health literacy did not have lower follow-up rates. Patient perception of having a low-risk for cardiac disease and a high level of trust in the emergency physician at the time of ED discharge are associated with lower follow-up rates in chest pain patients. Patients may commonly mistake their negative ED work up as proof that they do not have cardiac disease. Research evaluating the impact of informing patients of their calculated risk for cardiac disease, as well as providing patient education about the value of outpatient follow-up on appointment compliance, is needed.

Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population.

This exploratory study examined the facilitators of and barriers to acceptance of pre-exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India. A questionnaire was administered to 400 individuals registered with a targeted intervention programme. Logistic regression models were used to identify facilitators of and barriers to PrEP acceptance. The respondents consisted of 68% MSM and 32% TGs. Risk behaviour categorization identified 40% as low risk, 41% as medium risk and, 19% as high risk for HIV infection. About 93% of the respondents were unaware of PrEP, but once informed about it, 99% were willing to use PrEP. The facilitators of PrEP acceptance were some schooling [odds ratio (OR) 2.16; P = 0.51], being married or in a live-in relationship (OR 2.08; P = 0.46), having a high calculated risk (OR 3.12; P = 0.33), and having a high self-perceived risk (OR 1.8; P = 0.35). Increasing age (OR 2.12; P = 0.04) was a significant barrier. TGs had higher odds of acceptance of PrEP under conditions of additional cost (OR 2.12; P = 0.02) and once-daily pill (OR 2.85; P = 0.04). Individuals identified as low risk for HIV infection showed lower odds of potential risk compensation, defined as more sexual partners (OR 0.8; P = 0.35), unsafe sex with new partners (OR 0.71; P = 0.16), and decreased condom use with regular partners (OR 0.95; P = 0.84), as compared with medium-risk individuals. The associations, although not statistically significant, are nevertheless important for public health action given the limited scientific evidence on PrEP use among MSM and TGs in India. With high acceptability and a low likelihood of risk compensation behaviour, PrEP can be considered as an effective prevention strategy for HIV infection among MSM and TGs in India.

High-risk Behavior Among U.S. Military HIV-Infected Active-Duty and Retired Personnel

BackgroundDespite a high incidence of sexually transmitted infections (STIs), sexual behavior among U.S. military personnel remains understudied. Since 2014, the U.S. Military HIV Natural History Study has administered a behavioral questionnaire to a cohort of HIV-infected active-duty (AD) and retired personnel (RP). We compared patterns of risk behavior between AD and RP.MethodsMale participants who completed a behavioral questionnaire (n = 1,465) were included in this study. Chi-square and stepwise logistic regression were used to compare AD with RP. Our model included all behavioral variables listed below with adjustment for age and race. We assumed a priori that duty status would be correlated with age and selected the former as our variable of interest, hypothesizing that AD would engage in a higher number of risk behaviors.ResultsSelected demographics and behavioral data are summarized below.AD (n = 731) %RP (n = 734) %Univariate Odds (95% CI)Multivariate Odds (95% CI)DemographicsMedian Age (IQR)30 (26,37)51 (46,57)Race--White32.745.0--Black46.143.6--Hispanic/Other21.211.4Behavioral DataConsumed > 6 drinks on a single occasion (past year)50.932.12.2 (1.7,2.8)Ever experienced injury from drinking84.572.92.0 (1.6,2.6)Ever used hard drugs7.317.60.4 (0.3,0.5)0.5 (0.3,0.9)High self-perceived risk for STI22.119.11.3 (1.0,1.6)> 2 new sexual partners in past three months22.614.51.7 (1.3,2.3)Ever had sex with woman65.982.80.4 (0.3,0.5)Ever had sex with man82.179.81.2 (0.9,1.5)Condomless anal intercourse in last 3 mos (casual partner)29.527.21.1 (0.8,1.5)Condomless anal intercourse in last 3 mos (anonymous partner)22.318.21.3 (0.9,1.8)AD had significantly (P < 0.01) higher rates of gonorrhea (6.4) and chlamydia (6.0) per 100 person-years (py) than RP (2.2 and 1.6, respectively); syphilis rates did not differ between the groups (AD 1.2/100 py; RP 1.3/100 py).Conclusion In contrast with our hypothesis, we found a high prevalence of sexual risk behavior among both AD and RP, and only lifetime use of hard drugs was independently associated with duty status. Despite high STI rates, ~20% in either group reported high self-perceived risk for STIs and/or recent condomless sex with an anonymous partner. Our findings demonstrate a need for intensive STI screening and counseling among HIV-infected military personnel in multiple career stages.Disclosures All authors: No reported disclosures.

Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru.

The aim of the study was to identify factors associated with undiagnosed human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) and male-to-female transgender women in Lima, Peru.We analyzed characteristics of 378 MSM and transgender women recruited from 2 sexually transmitted infection (STI) clinics in Lima, Peru. Descriptive analyses compared: (A) HIV-uninfected, (B) previously undiagnosed HIV-infected, and (C) previously diagnosed HIV-infected participants. Multivariable logistic regression models identified: (1) correlates of previously undiagnosed HIV-infection among participants thought to be HIV-uninfected (B vs A); and (2) correlates of previously undiagnosed HIV-infection among HIV-infected participants (B vs C). Subanalysis identified correlates of frequent HIV testing among participants thought to be HIV-uninfected.Among participants, 31.0% were HIV-infected; of those, 35.0% were previously undiagnosed. Among participants thought to be HIV-uninfected (model 1), recent condomless receptive anal intercourse and last HIV test being over 1-year ago (compared to within the last 6-months) were associated with increased odds of being previously undiagnosed HIV-infected (adjusted odds ratio [aOR] = 2.43, 95% confidence interval [95%CI] = 1.10–5.36; aOR = 2.87, 95%CI = 1.10–7.53, respectively). Among HIV-infected participants (model 2), recent condomless receptive anal intercourse was again associated with previously undiagnosed HIV-infection (aOR = 2.54, 95%CI = 1.04–6.23). Achieving post-secondary education and prior syphilis infection were associated with lower odds of having previously undiagnosed HIV-infection (aOR = 0.35, 95%CI = 0.15–0.81; aOR = 0.32, 95%CI = 0.14–0.75, respectively).Reporting semiannual testing was associated with higher educational attainment, identifying as a transgender woman, or reporting a history of syphilis (aOR = 1.94, 95%CI = 1.11–3.37; aOR = 2.40, 95%CI = 1.23–4.70; aOR = 2.76, 95%CI = 1.62–4.71, respectively). Lower odds of semiannual testing were associated with recent condomless insertive anal intercourse or reporting a moderate or high self-perceived risk of acquiring HIV (aOR = 0.56, 95%CI = 0.33–0.96; aOR = 0.32, 95%CI = 0.18–0.59 and aOR = 0.43, 95%CI = 0.21–0.86, respectively).In our study, undiagnosed HIV-infection was associated with recent condomless receptive anal intercourse, infrequent HIV testing, lower education, and absence of prior syphilis diagnosis. Infrequent HIV testing was associated with lower education, not identifying as transgender, recent condomless insertive anal intercourse, absence of prior syphilis diagnosis, and higher self-perceived risk of HIV. Further efforts to decrease HIV transmission and increase HIV-serostatus awareness should be directed towards effectively promoting condom use and frequent HIV testing, integrated with STI management.