Self-perceived Risk Of HIV Infection Research Articles

216 Relationships Between Self-Perceived Risk of HIV, Behavioral Risk of HIV, and Self-Reported Pre-Exposure Prophylaxis (PrEP) Utilization Among Young Men Who Have Sex with Men of Color at Risk for HIV Infection: Findings From a Prospective Cohort Study

OBJECTIVES/GOALS: To improve our delivery of HIV prevention services by evaluating associations between self-perceived risk of HIV, objective risk for HIV based on sexual risk, and self-reported lifetime PrEP use. This will expand our current understanding of an essential component of decision making for PrEP uptake in young men who have sex with men (YMSM). METHODS/STUDY POPULATION: The population consists of participants in the Healthy Young Men (HYM) observational cohort study (16-24-year-old YMSM of color at risk for HIV in Los Angeles). Secondary analysis was conducted using an existing data set to test associations between self-perceived risk of HIV, behavioral sexual risk, and self-report of lifetime PrEP use at baseline. RESULTS/ANTICIPATED RESULTS: The HYM cohort consists of 397 HIV-negative young men who have sex with men from Los Angeles; 21% identify as African American/Black, 59% as Latinx, and 20% as multiethnic. Of these participants, 90% were aware of PrEP and 86% were eligible for PrEP according to CDC behavioral risk criteria; however, only 23% had ever been prescribed PrEP. We hypothesize that those who have utilized PrEP will report higher self-perceived risk of HIV infection and will have stronger correlation between self-perceived and objective risk for HIV. Associations will be tested using appropriate chi-square tests. DISCUSSION/SIGNIFICANCE: Self-perceived risk of HIV is proposed as a strong predictor of engagement in HIV prevention. This has been widely understudied in youth in the context of accessing PrEP. A better understanding of the role of self-perceived risk is essential to create and improve interventions to increase PrEP uptake as well as to improve PrEP service delivery for youth.

HIV Pre-exposure Prophylaxis at Two Urban Obstetrics/Gynecology Clinics in Buffalo: Awareness and Attitudes Among Non-Hispanic Black vs. Latinx Patients.

Non-Hispanic Black and Latinx women are disproportionately affected by HIV when compared to the general population. This study evaluated awareness of and attitude towards PrEP, self-perceived HIV infection risk, and factors constituting high-risk behavior for HIV infection at two general OB/GYN clinics in Erie County, which exhibited a 31.6% increase in HIV cases from 2019 to 2020. One thousand twenty-five self-administered surveys were analyzed. Of participants, 69.3% were non-Hispanic Black, 13.4% were Latinx, and 22.4% were White. There was no significant difference in awareness of or attitude toward PrEP between non-Hispanic Black and Latinx participants (p = 0.197, p = 0.467). Latinx participants exhibited the lowest awareness of PrEP compared with non-Hispanic Black and White participants (p = 0.002). In our high-risk group, most participants had low self-perceived risk of HIV infection and low awareness of PrEP, and most were unwilling or unsure as to whether they would take PrEP. This calls attention to a need for improved counseling regarding PrEP and what constitutes risk of HIV infection at our general OB/GYN clinics, with a potential focus on Latinx individuals.

Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study.

In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) ages 15 to 24 years represent <10% of the population yet account for 1 in 5 new HIV infections. Although oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) can be highly effective, low persistence in PrEP programs and poor adherence have limited its ability to reduce HIV incidence among women. A total of 336 AGYW participating in the PEPFAR-funded DREAMS PrEP program in western Kenya were enrolled into a study of PrEP use conducted between 6/2019 to 1/2020. AGYW, who used daily oral TDF/FTC, completed interviews and provided dried blood spots (DBS) for measurement of tenofovir-diphosphate (TFV-DP) concentrations at enrollment and 3 months later, and 176/302 (58.3%, 95% confidence interval [95% CI 52.3 to 63.8]) met our definition of PrEP persistence: having expressed intention to use PrEP and attended both the second interview and an interim refill visit. Among AGYW with DBS taken at the second interview, only 9/197 (4.6%, [95% CI 1.6 to 7.5]) had protective TFV-DP levels (≥700 fmol/punch) and 163/197 (82.7%, [95% CI 77.5 to 88]) had levels consistent with no recent PrEP use (<10 fmol/punch). Perception of being at moderate-to-high risk for HIV if not taking PrEP was associated with persistence (adjusted odds ratio, 10.17 [95% CI 5.14 to 20.13], p < 0.001) in a model accounting for county of residence and variables that had p-value <0.1 in unadjusted analysis (age, being in school, initiated PrEP 2 to 3 months before the first interview, still active in DREAMS, having children, having multiple sex partners, partner aware of PrEP use, partner very supportive of PrEP use, partner has other partners, AGYW believes that a partner puts her at risk, male condom use, injectable contraceptive use, and implant contraceptive use). Among AGYW who reported continuing PrEP, >90% indicated they were using PrEP to prevent HIV, although almost all had non-protective TFV-DP levels. Limitations included short study duration and inclusion of only DREAMS participants. Many AGYW persisted in the PrEP program without taking PrEP frequently enough to receive benefit. Notably, AGYW who persisted had a higher self-perceived risk of HIV infection. These AGYW may be optimal candidates for long-acting PrEP.

Effect of perceived HIV risk on initiation of antiretroviral therapy during the universal test and treat era in South Africa

BackgroundSouth Africa has not achieved the 90–90–90 goals, in part due to low rates of antiretroviral therapy (ART) initiation among those aware of their HIV status. Perceived risk of HIV at the time of testing may affect likelihood of rapid ART initiation. The purpose of this study was to evaluate factors associated with perceived risk of HIV and the relationship between perceived HIV risk and rapid ART initiation during the universal test and treat era which was adapted in October 2016.MethodsWe conducted a prospective study of adults undergoing HIV testing from October 2016–February 2019 at Ithembalabantu Clinic in Durban. Eligible participants reported not previously being diagnosed with HIV. Before HIV testing, participants were asked to assess their perceived HIV risk on a four-level scale. We categorized “definitely not” and “probably not going to acquire HIV” as a low perceived risk, and “probably will” and “definitely will become HIV-infected” as a high perceived risk of HIV infection. Participants were followed for up to 14 months following HIV testing to assess ART initiation.ResultsAmong 1519 people newly diagnosed with HIV, 55% were female and mean age was 33 years. Among those, 1382 (90.9%) had a high HIV risk perception and 137 (9.1%) reported low HIV risk perception. In the low risk group individuals were more likely to be female (58% vs 55%), unemployed (62% vs 59%), have a partner with unknown HIV status (61% vs 55%) compared to the high risk group. 83.2% of those with low HIV risk perception reported previously HIV testing compared 91.5% of those with high HIV risk perception. In the multivariate model, males were associated with a higher chances of initiating ART compared to females (adjusted hazard ratio (aHR): 1.187, CI 1.187 (1.060–1.329) and being unemployed (aHR 0.767 CI (0.650–0.905). Those with a low HIV risk perception were less likely to initiate ART 125 (91%) vs 1310 (95%) p = 0.022), and took longer to initiate on ART after HIV diagnosis (11 days’ vs 4 days, p = 0.042).ConclusionFactors associated with high HIV risk perception included being unemployed, single, and having a partner of unknown HIV status. People living with HIV (PLHIV) in South Africa who had a low self-perceived risk to HIV infection were less likely to initiate ART. Assessing self-perceived risk of HIV infection may help direct counselling and improve ART initiation to achieve universal 90–90–90 goal.

Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis

SummaryBackgroundMedical male circumcision (MMC) reduces HIV infection among heterosexual men. There are concerns MMC might prompt higher-risk sexual behaviours because of lower self-perceived risk of HIV infection. We reviewed the published literature to examine associations between MMC and both condom use and number of sex partners among heterosexual men.MethodsIn this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Library for studies published before Nov 15, 2020. Interventional and observational studies were included if they contained original quantitative data describing the association between MMC and condom use or number of sex partners among heterosexual men. We excluded data from men whose circumcisions were ritual or religious and data from men who have sex with men. We extracted odds ratios (ORs) and 95% CIs for the associations between MMC and condomless sex and MMC and multiple sex partners directly from the publications if available, selecting adjusted ORs when provided; when necessary, we calculated ORs and 95% CIs using original study data provided in the publication. We used the Mantel-Haenszel random effects model to calculate pooled ORs and 95% CIs.FindingsOur search yielded 3035 results, of which 471 were duplicates and 2537 did not meet the inclusion criteria. From the remaining 27 eligible studies, we identified 99 292 men from 31 independent population samples. 24 studies were done in Africa. We found no statistically significant associations between MMC and condomless sex (OR 0·91, 95% CI 0·80–1·05; k=30; I2=88·7%) or multiple sex partners (1·02, 0·88–1·18; k=27; I2=90·1%). No associations between MMC and condomless sex or multiple sexual partners were found in any subgroup analyses by study design, income of country, age, recruitment setting, circumcision assessment, circumcision prevalence, and risk of publication bias.InterpretationThe promotion of circumcision as an HIV preventive measure does not appear to increase higher-risk sexual behaviours in heterosexual men. Ongoing sexual health education should be maintained as a vital component of effective MMC programmes.

Who fails to return within 30\u2009days after being tested positive for HIV/STI in a free testing centre?

BackgroundSome patients who test positive for sexually transmitted infections (STIs) fail to return for results and treatment. To target improvement actions, we need to find out who these patients are. This study aimed to explore factors associated with failure to return within 30 days (FTR30) after testing among patients with positive results in a free STI testing centre in Paris.MethodsAll patients with at least one positive result between October 2016 and May 2017 and who completed a self-administered questionnaire were included in this cross-sectional study (n = 214). The questionnaire included sociodemographic factors, sexual behaviour and history of testing. Factors associated with FTR30 were assessed using logistic regression models.ResultsMore than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (22%). Men who had sex with men represented 36% of the study population. The FTR30 rate was 14% (95% CI [10–19%]). In multivariate analysis, previous HIV testing in younger persons (aOR: 3.36, 95% CI [1.27–8.84]), being accompanied by another person at the pretest consultation (aOR: 3.45, 95% CI [1.36–8.91]), and lower self-perceived risk of HIV infection (aOR: 2.79, 95% CI [1.07–7.30]) were associated with a higher FTR30. Testing for chlamydia/gonorrhoea without presumptive treatment was associated with a lower FTR30 (aOR: 0.21, 95% CI [0.07–0.59]).ConclusionsThese factors that affect failure to return are related to the patient’s representations and involvement in the STI screening process. Increasing health literacy and patient empowerment could help to decrease failure to return after being tested positive for HIV/STI.Trial registrationNot applicable.

HIV prevalence, knowledge and self-perceived risk of HIV infection among tuberculosis patients in Serbia.

The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ2 = 5.42; p &lt; 0.05) and decreases with the age of respondents (χ2 = 8.53; p &gt; 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.

To return or not to return for STI-HIV tests results: A study among 214 patients screened positive in a free center in Paris offering SMS reminders to reduce failure to return

Sexually transmitted infections (STI) are a major challenge in public health as nearly one million people become infected every day in the world with chlamydia, gonorrhoea, syphilis or trichomoniasis. Moreover, 2 millions of people become infected every year with HIV in the world. Despite progress in treatment and screening, incidence of STI continues to increase. To decrease the spread of STI, it is needed not only to focus on screening access but also to reduce the high proportion, 15–20%, of patients screened positive for at least one STI and who do not come back for their results generating delay in their medical care and risks of STI transmitting to their partners. In our free testing center for STI in Paris (France), in order to reduce failure to return, patients are offered the possibility of being notified by SMS after testing. If at least one of the STI results is positive, the SMS invites the patient to come back to the center to obtain his/her results. However, even when informed by up to three SMS, a part of patients still fails to return. To target improvement actions, it is needed to define their profile. This study aimed to explore factors associated with failure to return within 30 days after testing (FTR30) among patient screened positive for STI. Between October 2016 and May 2017, all patients with at least one positive result for STI testing (HIV, HBV, HVC, syphilis, gonorrhea and chlamydia) and who accepted to participate in the study were included (n = 214). Data were collected from the consultation database and a self-administered questionnaire. The FTR30 was measured based on information in the consultation database. This database also includes data on STI tested and results of the screenings performed. The self-questionnaire included socio-demographic factors, sexual behavior and factors related to the center visit. Factors associated with FTR30 were assessed using logistic regression models. The choice of the final multivariate model was based on the result of a backward stepwise selection with a 0.2 significance level for removal from the model. More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (25%). Men having sex with men represented 30% of the study population. The FTR30 rate was 14% (95% CI [10% > 19%]). Even if non-significant, FTR30 tend to be lower among the 72% of patients who accepted to be notified by SMS than among patients who did not (12% vs. 20%, P 0.10). In multivariate analysis, patients aged 25 or under were more likely to not return than patients older than 25 (aOR: 2.84; 95% CI: 1.09–7.41). A lower self-perceived risk of HIV infection was significantly associated with FTR30 (aOR: 3.05; 95% CI: 1.17–7.94), as well as not being tested for chlamydia and gonorrhea using self-swabbing (aOR: 5.98; 95% CI: 2.03–17.6). Probability of FTR30 was higher for patients coming with someone (aOR: 3.73; 95% CI: 1.41–9.88) compared to patients coming alone. The SMS program was well accepted but had a limited impact on FTR30 in our study population. To reduce the risk of failure in delivering STI screening results, systematic phone call after testing might also be proposed to patients. Moreover, no self-swabbing for chlamydia and gonorrhea testing and a lower self-perceived risk of HIV infection were associated with a higher probability of FTR30. Thus, improving STI/HIV knowledge and level of health literacy to empower patients would be an efficient way to decrease failure to return for results.

Modelling self-assessed vulnerability to HIV and its associated factors in a HIV-burdened country

Background: Globally, individuals’ self-assessment of vulnerability to HIV infection is important to maintain safer sexual behaviour and reduce risky behaviours. However, determinants of self-perceived risk of HIV infection are not well documented and differ. We assessed the level of self-perceived vulnerability to HIV infection in Nigeria and also identified its risk factors. Methods: We explored a recent nationally representative data with self-reported vulnerability (‘high’, ‘low’ and ‘no risk at all’) to HIV infection as the outcome of interest. Data were weighted and association between the outcomes and the risk factors determined. We used simple ordered logit regression to model relationship between the outcome variable and risk factors, and controlled for the significant variables in multiple ordered logistic regression at 5% significance level. Results: About 74% had good knowledge of HIV transmission and 6% had experienced STI recently. The likelihood of assessing oneself as having ‘no risk at all’ was 50% and for ‘high chances’ was 1.6%. Self-perceived high risk of HIV was higher among those who recently experienced STI (5.6%) than those who did not (1.7%), and also higher among those who recently engaged in transactional sex and had multiple sexual partners. The odds of good knowledge of HIV transmission on high self-perceived vulnerability to HIV was 19% higher than poor knowledge (OR = 1.19, 95% CI: 1.12–1.27). Also, respondents who recently had multiple sexual partners were 72% (OR = 1.72, 95% CI: 1.60–1.86) more likely to report self as having high risk. Younger respondents aged 14–19 years had higher odds of 41% (OR = 1.41, 95% CI: 1.29–1.55) to perceive self as having high vulnerability to HIV than older respondents. Conclusion: High vulnerability to HIV infection was reported among younger respondents, those with history of STIS and those who engage in multiple sexual relations. Despite high level of risky sexual behaviour and good knowledge of HIV transmission and prevention found in this study, self-perceived vulnerability to HIV generally is low. For the low perception found in this study to translate to low chance of HIV infection, there is need for all stakeholders to embark on risk reduction initiatives through sexual education that would minimise risky sexual practices and ensuring availability and affordability of HIV prevention methods.

Risk Behaviour of HIV Positive Individuals who are Aware of their Serostatus:Evidence from the 2012 HIV Population-based Household Survey in South Africa

Introduction: HIV positive people are the main source of new infections, which occur mainly through risk behaviours with a high-risk partner. Awareness of HIV status has been proposed as a key factor underlying sexual and HIV risk behaviour. This study sought to determine whether awareness of one’s HIV positive status translates to reduced sexual risk behaviour among HIV positive individuals. Methods: The analysis was based on the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, which included socio-demographic characteristics, age at sexual debut, age disparate partnerships, multiple sexual partners, condom use at last sex, self-perceived risk of HIV infection and alcohol use. Bivariate and multivariate logistic regression was used to assess sexual and HIV risk behavioural factors associated with awareness of HIV status. Results: Of 2565 HIV positive individuals, 48.3% reported that they were aware of their HIV status while the remainder indicated they were aware not aware of their HIV status. HIV positive females were more likely to report that they knew their status than their male counterparts [OR=1.6 (95% CI: 1.0-2.7), p=0.049]. Knowing that one was HIV positive was associated with increased likelihood of condom at last sex [OR=1.5 (95% CI: 1.1-2.0), p=0.010], low risk perception of HIV infection ([OR=0.7 (95% CI: 0.5-0.9), p=0.011], and reduced likelihood of risky/hazardous drinking of alcohol among males [OR=0.3 (95% CI: 0.2-0.6), p<0.001]. Conclusion: The current findings confirm that gaining knowledge of one's own HIV status is key to adopting HIV prevention behaviours. Given the large number of people living with HIV/AIDS in South Africa more efforts should be made to promote positive prevention programmes.

P09.31 Factors associated with syphilis seroreactivity among polydrug users in northeast brazil: a cross-sectional study usingrespondent driven sampling

Introduction The burden of sexually transmitted infections (STIs), such as syphilis, is greatest in median and low-income countries with serious consequences to sexual and reproductive health and increased risk to HIV infection. The prevalence of syphilis among drug users is higher than in the general population. Our aim is to report the rate of syphilis seroreactivity and associated factors among polydrug users (PDUs) in Northeast Brazil. Methods A cross-sectional study recruited 424 PDUs in Northeast Brazil through respondent driven sampling in 2009. Data was collected data using audio computer-assisted self-interview and rapid tests used for syphilis screening. Multivariable logistic regression was used to estimate factors associated with syphilis seroreactivity. Estimates were weighted by the inverse of the participant social network size. Results Mean age was 29.3 years (range: 18–62), 74.0% were males, and 89.8% were non-white. Syphilis seroreactivity was 16.6%. Being female (wOR: 2.14, 95% CI: 1.09–4.20), over 29 years old (wOR: 4.44, 95% CI: 2.41–8.19), exchange sex for money or drugs (wOR: 3.51, 95% CI: 1.84–6.71), “No/low” self-perceived risk of HIV infection (wOR: 5.13, 95% CI: 1.36–19.37), and having nine or less years of education (wOR: 2.92, 95% CI: 1.08–7.88) were associated with syphilis seroreactivity. Conclusion One of the most urgent needs for syphilis prevention and control is the availability of rapid point-of-care diagnostic tests and treatment, including the integration of STIs services into primary health-care and HIV-care/prevention settings. Gender issues, education in health, access to public services, social interventions focusing human rights, and social inequalities need more coverage for most at risk populations. Disclosure of interest statement This study was funded by the Brazilian Ministry of Health/Department of SDT/AIDS and viral hepatitis, with technical advisor from CDC Brazil. The first author is supported by a grant from the Brazilian National Research Council (CNPq) for his PhD studies.

Self-Perceived Risk of HIV Infection and Attitudes About Preexposure Prophylaxis Among Sexually Transmitted Disease Clinic Attendees in South Carolina

Several domestic and international trials of the use of preexposure prophylaxis (PrEP) for HIV prevention are ongoing among groups at high risk for HIV infection. The objective of this cross-sectional study was to assess self-perceived risk of HIV infection and attitudes about PrEP among 405 sexually transmitted disease (STD) clinic attendees in South Carolina. Self-percieved risk of HIV infection and attitudes about PrEP were assessed using three questions from a self-administered survey. Ordinal logistic regression and logistic regression were used to evaluate differences in risk perception for HIV infection and attitudes about the use of PrEP among risk groups. Compared to heterosexual participants, homosexual participants were significantly more likely to have knowledge of PrEP (odds ratio [OR]=6.7, 95% confidence interval [CI]: 1.70-26.1). Compared to those participants who had 1 sexual partner in the past 3 months, individuals who had 2 to 4 sexual partners in the past 3 months were approximately 2.35 times as likely to have a lower level of agreement with the statement "I believe I am at risk of getting HIV" (p=0.0003). Compared to female participants, respondents who were male were approximately 2.8 times as likely to have a lower level of agreement with the statement "If I had to it would be very difficult for me (or my partner) to both use condoms and take daily pills to prevent HIV infection" (p<0.0001). These results suggest the need for the creation of PrEP implementation programs that are tailored to self-perceived risk perception, age, and gender.

Impact of HIV infection on self-rated health in a high-prevalence popolation with low awareness of own HIV status

Background: Self-rated global health status has been found to be a sensitive marker of declining health and to operate as an independent predictor of survival. This study examines the effect of HIV infection on self-rated health in a population with high prevalence of HIV infection and low awareness of own status of HIV infection. Methods: The data stem from a comprehensive population-based HIV survey conducted in selected urban and rural populations in Zambia in 1996. A total of 1951 males and 2158 females of age more than 14 years were interviewed of which 6% refused to be tested for HIV infection. A logistic regression model was used assuming socio-demographic factors, mental distress and health care use to be associated both with HIV infection and self-rated health. Results: The proportion of persons judging their health status as poor was higher in the rural than in the urban population. Generally no major difference in the proportions of persons rating their health status as poor was observed between sexes. The proportion of poor self-rated health status increased linearly with age. Use of health care services, mental distress and self-perceived risk of HIV infection were negatively associated with self-rated health. Both males and females living in an urban area and males living in a rural area of age more than 24 years who were infected with HIV were about twice as likely to rate their health status as poor compared to respondents who were not infected with HIV. Conclusion: HIV infection had a strong independent negative effect on self-rated health in persons of age greater than 24 years. This measure of people’s subjective health may be used as a valuable “diagnostic” tool in HIV-related care and support programmes, and should be evaluated for use in such services.

HIV/AIDS Misconceptions Among Latinos: Findings From a Population-Based Survey of California Adults

Misconceptions about HIV/AIDS among Latino adults (N = 454) in California were examined using data from a population-based telephone survey conducted in 2000. Common misconceptions concerning modes of HIV transmission included transmission via mosquito or animal bite (64.1%), public facilities (48.3%), or kissing someone on the cheek (24.8%). A composite misconceptions score was constructed. Correlations between the composite measure and other HIV/AIDS-related beliefs were examined. Latinos with a higher level of misconceptions were more likely to report higher self-perceived risk of HIV infection, and discomfort with infected individuals in a school and in a food setting. Results from multiple linear regression analysis indicated that individuals 45 years and older, those who were interviewed in Spanish, and those with lower education or income levels had a higher degree of misconceptions. The results suggest the need for targeted education efforts to reduce HIV/AIDS misconceptions among Latino adults in California.

Extramarital Sex Among Nigerian Men

The AIDS epidemic in Nigeria is generalized, with infection primarily occurring through heterosexual transmission. It is important to understand patterns of sexual behavior to assess their impact on the epidemic and to design appropriate intervention strategies. This study examined risk factors for extramarital sex among Nigerian men, with a particular focus on polygyny and peri- and postpartum abstinence. Data from the 2003 Nigeria Demographic and Health Survey were analyzed for 1153 men and their wives. Eleven percent of men reported extramarital sex in the previous year. Logistic regression models showed that men with 3 or more wives were at the greatest risk for extramarital sex, followed by monogamous men, when compared with men with 2 wives. Other significant predictors included region, religion, wealth, age at sexual debut, and self-perceived risk of HIV infection. Peri- and postpartum abstinence was not significant. Based on these findings, HIV prevention programs should include men with 3 or more wives and those living in the southwest region, in addition to activities targeting men of all ages. Given the heterogeneity within Nigeria, further in-depth studies should be undertaken to explore the relation between number of wives, peri- and postpartum abstinence, and extramarital sex within specific communities.

Surveillance of HIV/AIDS-related attitudes and perceptions among the general public in Hong Kong from 1994 to 2000.

The present study monitored the trends of HIV/AIDS-related attitudes and perceptions including awareness, knowledge, self-perceived risk of HIV infection, and program evaluation among the general public in Hong Kong over a period of 7 years. Six cross-sectional telephone surveys were conducted. A total of 6,795 respondents aged 18-50 randomly selected from the general population participated in the study. Over the study period, the level of HIV/AIDS-related knowledge has improved slightly for most of the studied items. Condom use has been more widely accepted as an efficacious means of HIV prevention. However, the public seemed to be losing interest in HIV/AIDS-related issues and were not satisfied with the efficacy and adequacy of HIV/AIDS programs in Hong Kong. Sustaining efforts to remove misconceptions and to raise the public's interest, formulation of more effective programs, and ongoing evaluation are necessary.