What Leads Some People to Think They Are HIV-Positive Before Knowing Their Diagnosis? Psychological And Behavioural Correlates of HIV-Risk Perception

Current HIV-risk perception refers to the extent to which individuals think they might be HIV-positive. This belief, distinct from the perceived risk about being infected with HIV in the future, is likely to have a range of important consequences. These consequences may include both psychological effects (e.g., impacts on well-being) and behavioural effects (e.g., HIV testing uptake). Given these possible outcomes, and the suggested importance of risk perception in health behaviour models, understanding the behavioural and psychological antecedents of current HIV-risk perception is crucial. 

This systematic review investigates the relationship between behavioural and psychological factors and current HIV-risk perception (in individuals who are unaware of their actual HIV status). Eight studies were eligible for inclusion in the review (five quantitative and three qualitative studies). Drug risk behaviour and sexual risk behaviour (both self and partner) were often associated with current HIV-risk perception, although other studies failed to show a relationship between one's own sexual risk behaviour and risk perception. Psychological factors were only rarely assessed in relation to current HIV-risk perception. Where these variables were included, there was evidence that experiencing symptoms perceived to be consistent with HIV and prompts to test were associated with increased current HIV-risk perception. 

These findings are consistent with the Common-Sense Model (CSM) of illness representation and self-regulation. Methodological quality criteria were rarely met for the included studies. 

In addition, it was often difficult to ascertain whether potentially includable studies were eligible due to imprecise definitions of HIV-risk perception. 

Research and practice implications are discussed, with particular emphasis on the role of risk appraisals as a potential mediator of the relationship between HIV-risk behaviour, symptoms and current HIV-risk perception.

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By:  Evangeli M1, Baker LL1, Pady K1, Jones B1, Wroe AL1.

• 1a Department of Psychology , Royal Holloway University of London , Egham , UK. 
• AIDS Care. 2016 Feb 6:1-11. [

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The Need to Know: HIV Status Disclosure Expectations & Practices among Non-HIV-Positive Gay & Bisexual Men in Australia

Although there is evidence of increasing overall rates of HIV status disclosure among gay and bisexual men, little is known about men's disclosure expectations and practices. 

In this study, we investigate the importance non-HIV-positive men in Australia vest in knowing the HIV status of their sexual partners, and the extent to which they restrict sex to partners of the same HIV status, and their HIV disclosure expectations. Data were collected through a national, online self-report survey. 

Of the 1044 men included in the study, 914 were HIV negative and 130 were untested. Participants completed the assessment of socio-demographic characteristics, HIV status preferences, and disclosure expectations and practices. Participants also completed reliable multi-item measures of perceived risk of HIV transmission, expressed HIV-related stigma, and engagement with the gay community and the community of people living with HIV. 

• A quarter (25.9%) of participants wanted to know the HIV status of all sexual partners, and 
• one-third (37.2%) restricted sex to partners of similar HIV status. 
• Three quarters (76.3%) expected HIV-positive partners to disclosure their HIV status before sex, compared to 41.6% who expected HIV-negative men to disclose their HIV status. 
• Less than half (41.7%) of participants reported that they consistently disclosed their HIV status to sexual partners. 

Multivariate linear regression analysis identified various covariates of disclosure expectations and practices, in particular of disclosure expectations regarding HIV-positive men. Men who expected HIV-positive partners to disclose their HIV status before sex more often lived outside capital cities, were less educated, were less likely to identify as gay, perceived more risk of HIV transmission from a range of sexual practices, were less engaged with the community of people living with HIV, and expressed more stigma towards HIV-positive people. 

These findings suggest that an HIV-status divide is emerging or already exists among gay men in Australia. HIV-negative and untested men who are most likely to sexually exclude HIV-positive men are less connected to the HIV epidemic and less educated about HIV risk and prevention.

Expectations of disclosure, consistent self-disclosure, and of serostatus preferences.

	Mean (SD)	Agree (%)
I only have sex with someone whose HIV status I know	2.54 (1.42)	25.9
I only have sex with someone whose HIV status is similar to mine	2.88 (1.51)	37.2
I'd expect an HIV+ man to tell me he was HIV+ before we had sex	4.13 (1.29)	76.3
I'd expect an HIV- man to tell me he was HIV- before we had sex	3.14 (1.48)	41.6
I always tell my sex partner what my HIV status is before we have sex	3.11 (1.54)	41.7

In this study, we found a number of factors to be associated with expecting disclosure from HIV-positive men. Multivariate analyses showed that HIV-negative and untested men who expected HIV-positive men to disclose their HIV status were more likely to live outside capital cities, were less likely to have a university education, perceived greater risk of HIV transmission from a range of sexual practices, expressed more HIV-related stigma, and were less engaged with the community of PLHIV. We found that HIV-negative and untested men who expected their HIV-negative sex partners to disclose their HIV status were more likely to live outside capital cities, less likely to have a university education, and perceived greater risk of HIV transmission from a range of sexual practices. Consistent self-disclosure of their HIV status among these HIV-negative and untested men was also associated with living outside capital cities and perceiving greater risk of HIV transmission from a range of sexual practices, as well as with a lower number of sexual partners in the past year.

Perceiving greater risk of HIV transmission from engaging in a range of sexual practices with an HIV-positive partner whose viral load is unknown was independently associated with disclosure expectations for HIV-positive and HIV-negative men, as well as with consistent self-disclosure. This association between HIV status disclosure expectations and practices and perceived risk suggests a strong association between concern about HIV and identifying and avoiding potential sexual partners who are HIV positive. The association between expectations of HIV-positive status disclosure and both greater HIV-related stigma and less engagement with the community of PLHIV, suggests broad social exclusion and provides further evidence of a serostatus divide among gay men.

These findings of high expectations of HIV-positive men to disclose, and strong preferences among some men to exclude HIV-positive men as sex partners indicate the paradox of disclosure for HIV-positive men. They are expected to disclose their HIV status, and yet doing so may result in being rejected as a potential partner. Also, although the dramatic increases in disclosure of HIV status to sex partners documented over the past decade may have been influenced by the increasing adoption of risk-reduction strategies such as serosorting, our findings provide evidence of high expectations to disclose HIV-positive status in general. These findings also suggest, as we have argued elsewhere, that HIV-related stigma is a continuing issue among gay men, especially in the area of sex and relationships (de Wit et al., ²⁰¹³). Such stigmatizing practices may also have a negative effect on current strategies that encourage men to undertake more frequent HIV testing.

  

Full article at:   http://goo.gl/4E1uAw

By:  Dean A. Murphy, ^{a , b , *} John B.F. de Wit, ^{a , c} Simon Donohoe, ^d and Philippe C.G Adam ^a

^aCentre for Social Research in Health, UNSW, Sydney, Australia

^bNational Drug Research Institute, Curtin University, Melbourne, Australia

^cDepartment of Social and Organizational Psychology, Utrecht University, Utrecht, The Netherlands

^dAustralian Federation of AIDS Organisations, Sydney, Australia

^* Corresponding author. Email: ua.ude.wsnu@yhprum.d

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Sexual Behavior, Risk Perception & HIV Transmission Can Respond to HIV Antiviral Drugs & Vaccines through Multiple Pathways

There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. 

Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. 

For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms.

Below: Baseline scenario with no interventions: (a) number of HIV—(green) and HIV+ (red) individuals in the population; (b) averageb_t-value for HIV—individuals by age, 15-20-year-olds (red), 20–30 (orange), 30–40 (yellow), 40–50 (green), and 50+ year-olds (blue); (c) average b_t-values for HIV+ individuals by same age groups; (d) number of HIV+ individuals by the same age groups, and with black representing the total number of HIV+ individuals; (e) total average b_t-value for HIV+ (red) and HIV—(green) populations; (f) HIV prevalence (percentage of the population currently infected).

Below:  Figure 2: Baseline scenario with no interventions. (a) total number of −/+ US acts (number of unprotected sex acts between HIV− and HIV+ pairs) per year divided by number of HIV—individuals in that age cohort at the end of the year, for age groups 15–20-year-olds (red), 20–30 (orange), 30–40 (yellow), 40–50 (green), and 50+ year-olds (blue), and cumulative number of individuals across all age groups (black); (b) total number of −/+ US acts per year, for same age groups; (c) number of HIV—individuals in each age cohort at the end of the year, for same age groups.

Below:  Figure 3: Baseline scenario for HAART intervention: (a) number of HIV− (green) and HIV+ (red) in the population; (b) average b_t-value for HIV− individuals by age, 15–20-year-olds (red), 20–30 (orange), 30–40 (yellow), 40–50 (green), and 50+ year-olds (blue); (c) average b_t-values for HIV+ individuals by same age groups; (d) number of HIV+ individuals by the same age groups, and with black representing the total number of HIV+ individuals; (e) total average b_t-value for HIV+ (red) and HIV− (green) populations; (f) HIV prevalence (percentage of population currently infected).

Below:  Figure 4: Baseline scenario for HAART intervention. (a) total number of −/+ US acts (number of unprotected sex acts between HIV− and HIV+ pairs) per year divided by number of HIV—individuals in that age cohort at the end of the year, for age groups 15–20-year-olds (red), 20–30 (orange), 30–40 (yellow), 40–50 (green), and 50+ year-olds (blue), and cumulative number of individuals across all age groups (black); (b) total number of −/+ US acts per year, for same age groups; (c) number of HIV—individuals in each age cohort at the end of the year, for same age groups.

Below:  Figure 5: Baseline scenario for vaccine intervention. (a) number of HIV− (green) and HIV+ (red) in the population; (b) average bt-value for HIV− individuals by age, 15–20-year-olds (red), 20–30 (orange), 30–40 (yellow), 40–50 (green), and 50+ year-olds (blue); (c) average bt-values for HIV+ individuals by same age groups; (d) number of HIV+ individuals by the same age groups, and with black representing the total number of HIV+ individuals; (e) total average bt-value for HIV+ (red) and HIV− (green) populations; (f) HIV prevalence (percentage of population currently infected).

Below:  Figure 6 Baseline scenario for vaccine intervention. (a) total number of −/+ US acts (number of unprotected sex acts between HIV− and HIV+ pairs) per year divided by number of HIV—individuals in that age cohort at the end of the year, for age groups 15–20-year-olds (red), 20–30 (orange), 30–40 (yellow), 40–50 (green), and 50+ year-olds (blue), and cumulative number of individuals across all age groups (black); (b) total number of −/+ US acts per year, for same age groups; (c) number of HIV—individuals in each age cohort at the end of the year, for same age groups.

Full article at: http://goo.gl/kbKoKB

By: Tully S1, Cojocaru M1, Bauch CT1,2.

• 1Department of Mathematics and Statistics University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1 Canada.
• 2Department of Applied Mathematics University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1 Canada.  

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How Target and Perceiver Gender Affect Impressions of HIV Risk

People do not use condoms consistently but instead rely on intuition to identify sexual partners high at risk for human immunodeficiency virus (HIV) infection. The present study examined gender differences of intuitive impressions about HIV risk.

Male and female perceivers evaluated portraits of unacquainted male and female targets regarding their risk for HIV, trait characteristics (trust, responsibility, attractiveness, valence, arousal, and health), and willingness for interaction.

Male targets were perceived as more risky than female targets for both perceiver genders. Furthermore, male perceivers reported higher HIV risk perception for both male and female targets than female perceivers. Multiple regression indicated gender differences in the association between person characteristics and HIV risk. In male targets, only trustworthiness predicts HIV risk. In female targets, however, HIV risk is related to trustworthiness, attractiveness, health, valence (for male perceivers), and arousal (for female perceivers).

The present findings characterize intuitive impressions of HIV risk and reveal differences according to both target and perceiver gender. Considering gender differences in intuitive judgments of HIV risk may help devise effective strategies by shifting the balance from feelings of risk toward a more rational mode of risk perception and the adoption of effective precautionary behaviors.

Below:  Mean HIV ratings rank-ordered for the four groups defined by the factors “Target Gender” and “Perceiver Gender.”

Full article at: http://goo.gl/wZrPiW

By: Alexander Barth,1 Ralf Schmälzle,1 Freda-Marie Hartung,1 Britta Renner,1 and Harald T. Schupp1,*

¹Department of Psychology, University of Konstanz, Konstanz, Germany

Edited by: Philippe C. G. Adam, The University of New South Wales, Australia

Reviewed by: Anthony Santella, Hofstra University, USA; Fraukje E. F. Mevissen, Maastricht University, Netherlands

*Correspondence: Harald T. Schupp, Department of Psychology, General Psychology, University of Konstanz, P. O. Box 36, Konstanz 78457, Germany, Email: ed.znatsnok-inu@ppuhcs.dlareh

Specialty section: This article was submitted to HIV and AIDS, a section of the journal Frontiers in Public Health

  

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