Kesler Maya A, Kaul Rupert, Liu Juan, Loutfy Mona, Gesink Dionne, Myers Ted, Remis Robert S
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
BMC Public Health. 2016 Mar 11;16:254. doi: 10.1186/s12889-016-2859-6.
Theory suggests that perceived human immunodeficiency virus (HIV) risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk.
Sexually active men who have sex with men (MSM) were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI). Actual HIV risk (primary predictor) was constructed by applying principal component analysis (PCA) to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome) was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk.
One hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37-50 years]). Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR) 18.33, 95% confidence interval (CI) 1.65-203.45). Older age was associated with lower perceived risk but only age 40-49 compared to less than 30 was statistically significant (OR 0.12, 95% CI 0.016-0.86). The odds of having high perceived risk was significantly associated with men who used poppers in the previous 6 months compared to those who did not use poppers (OR 5.64, 95% CI 1.20-26.48).
Perceived HIV risk increased significantly as condom use with an HIV-positive regular partner decreased. However, perceived HIV risk was not associated with condom use with casual partners or HIV unknown status regular partners, even though these behaviours could be considered risky. The relationship between perceived and actual risk in HIV studies is complex and has implications on how health care workers address the issue of risky sexual behaviour and perceived risk.
理论表明，感知到的人类免疫缺陷病毒（HIV）风险与实际的HIV风险行为呈周期性变化，即从事高风险行为会增加感知风险，从而引发预防行为，降低实际风险，并随着时间的推移降低感知风险。虽然当前的感知风险可能会影响未来的实际风险，但之前的实际风险如何塑造当前的感知风险尚不清楚。如果个体不根据过去的行为来确定当前的感知风险，他们就会失去感知风险激发预防行为的保护作用。我们的目标是确定实际风险对感知风险的影响。
2010年9月至2012年6月，在多伦多市中心的枫叶医疗诊所招募了有性行为的男男性行为者（MSM）。参与者使用音频计算机辅助自我访谈（ACASI）完成了一份社会行为问卷。通过对八个性风险调查问题应用主成分分析（PCA）构建实际HIV风险（主要预测因素），其包括三个成分，分别反映与临时性伴侣发生性行为、与HIV阳性固定伴侣发生性行为以及与HIV感染状况未知的固定伴侣发生性行为。通过询问参与者感染HIV的可能性来测量感知HIV风险（结果）。使用多变量逻辑回归来测量实际和感知HIV风险之间的关联。
招募了150名HIV阴性的MSM（中位年龄44.5岁[四分位间距37 - 50岁]）。20%的MSM认为自己感染HIV的风险很高。与使用避孕套比例高表明实际HIV风险低的与HIV阳性固定伴侣发生性行为的人相比，与HIV阳性固定伴侣发生性行为时避孕套使用比例低表明实际HIV风险高的人，其感知风险高的几率显著更高（优势比（OR）18.33，95%置信区间（CI）1.65 - 203.45）。年龄较大与较低的感知风险相关，但只有40 - 49岁与小于30岁相比具有统计学意义（OR 0.12，95% CI 0.016 - 0.86）。与未使用Poppers的男性相比，在过去6个月内使用Poppers的男性感知风险高的几率显著更高（OR 5.64，95% CI 1.20 - 26.48）。
随着与HIV阳性固定伴侣发生性行为时避孕套使用比例的降低，感知HIV风险显著增加。然而，感知HIV风险与与临时性伴侣发生性行为时的避孕套使用或与HIV感染状况未知的固定伴侣发生性行为时的避孕套使用无关，尽管这些行为可被视为有风险。HIV研究中感知风险与实际风险之间的关系很复杂，对医护人员如何处理危险性行为和感知风险问题具有启示意义。
