DataFirst, University of Cape Town, Cape Town, South Africa.
BMC Public Health. 2023 Jan 28;23(1):188. doi: 10.1186/s12889-022-14862-7.
Perception of risk is a central construct of models of health behaviour change as it is assumed to be an intermediate step before adoption of the related safer behaviour. In the context of HIV/AIDS, the literature suggests that psychosocial factors such as stigmatising attitudes related to stereotyping people who contract HIV may influence how people perceive their own risk of HIV infection. However, findings on the relationships between HIV-related stigma, HIV risk perception and sexual behaviour have been inconsistent. We investigated the potential mediating role of HIV risk perception on the link between HIV-related symbolic stigma and sexual behaviour.
Data used in this study are a sub-sample of 384 young adult women, aged 17-25 years, who participated in the Cape Area Panel Study conducted in Cape Town, South Africa. Study participants were asked questions relating to their demographic details, their social and economic situation, and sexual and reproductive health behaviour. The outcome measure was a composite measure of sexual behaviour derived from whether the young adult women ever had sex before, previous number of sexual partners and condom use. The mediator variable was self-perceived risk of contracting HIV. The independent variable was HIV-related symbolic stigma attitudes. Mediation analysis within the structural equation modeling (SEM) framework was used to examine if participants who held elevated stigma attitudes perceived their risk of HIV infection to be low and as a result ended up engaging in unsafe sex.
Higher HIV-related symbolic stigma attitudes were associated with perception of reduced risk of contracting HIV (β = -0.248, p = 0.008, 95% CI = [-0.431, -0.066]) and perception of higher risk of contracting HIV was significantly associated with unsafe sex practices (β = 0.179, p = 0.038, 95% CI = [0.010, 0.348]). The indirect path was not significant (β = -0.044, p = 0.084, 95% CI = [-0.095, 0.006]), suggesting no mediation relationship.
Stigmatising attitudes towards groups of people stereotyped as at risk of HIV infection was associated with perception of invulnerability to HIV, and the question on how this relationship affects risk sexual behaviour needs further investigation.
风险感知是健康行为改变模型的一个核心构建，因为它被认为是采取相关更安全行为之前的中间步骤。在艾滋病毒/艾滋病方面，文献表明，与对感染艾滋病毒的人的刻板印象相关的污名化态度等心理社会因素可能会影响人们对自己感染艾滋病毒风险的感知。然而，与艾滋病毒相关的耻辱感、艾滋病毒风险感知和性行为之间的关系的研究结果一直不一致。我们研究了艾滋病毒风险感知在艾滋病毒相关象征耻辱感与性行为之间的潜在中介作用。
本研究使用的数据是来自南非开普敦进行的开普敦地区小组研究的 384 名年龄在 17-25 岁的年轻成年女性的子样本。研究参与者被问及与他们的人口统计细节、社会经济状况以及性行为和生殖健康行为有关的问题。结果衡量标准是从年轻成年女性是否有过性行为、以前的性伴侣数量和使用避孕套的情况得出的性行为综合衡量标准。中介变量是自我感知的感染艾滋病毒的风险。自变量是艾滋病毒相关的象征耻辱感态度。使用结构方程模型（SEM）框架内的中介分析来检验是否持有较高耻辱感态度的参与者感知到他们感染艾滋病毒的风险较低，结果导致不安全的性行为。
较高的艾滋病毒相关象征耻辱感态度与感知感染艾滋病毒的风险降低有关（β=-0.248，p=0.008，95%置信区间=-0.431，-0.066），而感知感染艾滋病毒的风险较高与不安全的性行为显著相关（β=0.179，p=0.038，95%置信区间=0.010，0.348）。间接路径不显著（β=-0.044，p=0.084，95%置信区间=-0.095，0.006），表明不存在中介关系。
对被刻板印象为感染艾滋病毒风险较高的群体的污名化态度与对艾滋病毒不易感染的感知有关，需要进一步研究这种关系如何影响风险性行为。
