San Diego State University, Institute for Behavioral and Community Health and School of Public Health, San Diego, CA.
Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA.
J Acquir Immune Defic Syndr. 2021 Apr 15;86(5):e126-e133. doi: 10.1097/QAI.0000000000002614.
To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions.
Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group.
Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment.
Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
要终结艾滋病流行，就必须让感染艾滋病风险最高的男男性行为者（MSM）了解艾滋病预防和暴露前预防（PrEP）措施。本研究从定性角度探讨了临床医生、科学家和公共卫生官员用于客观评估艾滋病风险的常用指标是否与 MSM 对艾滋病风险的认知以及影响 MSM 风险感知的因素相符。
本研究对 20 名 HIV 阴性的年轻 MSM（年龄 19-24 岁，60%拉丁裔；n=20）进行了访谈，这些访谈是在重复 HIV 检测的背景下进行的，以考察 HIV 风险的概念化。迭代应用主题分析检验了参与者如何概念化和构建他们的 HIV 风险，并将参与者对其风险的描述与一种经过验证的 HIV 风险定量评估进行了比较，这种定量评估能够可靠地预测该人群的 HIV 血清转化。
客观的 HIV 风险定量评估与参与者感知的 HIV 风险不一致。参与者以相对术语描述他们当前的风险（相对于过去的风险和相对于朋友/同伴的风险），并描述了年龄/发展阶段和对 HIV 预防知识的变化，这些都是随着时间推移风险变化的关键因素。其他因素包括物质使用和对性伴侣的信任/不信任以及 HIV 预防方面的科学进步（例如 U = U 和 PrEP）。无论客观风险评估如何，影响参与者感知 HIV 风险的因素都相似。
定量评估的风险可能与 MSM 的风险感知不一致。尽管客观指标可以有效地针对 HIV 传播风险最高的 MSM，但为了改善预防行为和 PrEP 使用率，干预措施可能更有效，方法是缩小客观 HIV 风险评估与 MSM 对风险的构建之间的差距。
