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HIV Risk Perception Does Not Match PrEP Interest in US Heterosexual Group
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51st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 17-20, 2011, Chicago
Mark Mascolini
Although heterosexuals surveyed at a Chicago sexually transmitted infection (STI) clinic had a good understanding of HIV transmission risk and were rated as high risk by researchers, fewer than 20% perceived themselves to be at high risk of HIV infection [1]. More than 80% of men and women in this high-risk heterosexual group said they would take a pill for pre-exposure prophylaxis (PrEP). But high-risk people who mistakenly saw themselves as having a low HIV risk tended to have no interest in PrEP.
Three placebo-controlled trials found that PrEP with tenofovir or tenofovir/emtricitabine lowers the risk of HIV acquisition in men who have sex with men (MSM) [2] and in African heterosexuals [3,4] at high risk of HIV infection. Although these findings stirred wider interest in PrEP, limited research has addressed questions of HIV risk perception and its impact on interest in PrEP.
This anonymous survey of people attending a Chicago STI clinic took place from August through October 2010, ending about a month before release of the first PrEP trial results (in MSM) [2]. The survey quizzed people about demographics, risk behaviors, substance use, knowledge about HIV transmission risks, and PrEP interest. Using predefined HIV risk traits, the researchers classified survey respondents into high-risk, moderate-risk, and low-risk behavior/environment groups.
Of the 494 people who answered the survey, 435 (88%) were heterosexual, 346 (70%) African American, and 311 (63%) men. The investigators classified 83% as being a high risk for HIV infection, 10% at moderate risk, and 7% at low risk. The analysis focused on 359 heterosexuals rated as having a high HIV risk by the researchers; 234 people in this group (65%) were men and 125 women. While 58 of these 359 people (16%) believed they had a high risk of HIV infection, 301 (84%) thought they had a low risk.
More than two thirds of these 359 people (79%) were black, 15% were Hispanic, 5% were white, and the rest were another race or ethnicity. About one third of this group (36%) was unemployed, 79% had a high school education or less, and 82% had a monthly household income below $2000. More than half of the men (55%) and almost one quarter of the women (23%) had been in jail or prison, but only small proportions (5% of men and 3% of women) reported ever injected drugs. While 15% of women reported exchanging sex for money or drugs, 6% of men reported doing so. About one third of men and women reported drinking alcohol before sex at least half the time.
More than 80% of this group correctly answered most questions about HIV transmission. But 301 of these 359 high-risk people (84%) perceived themselves as having a low risk of HIV infection. Incorrect perception of low HIV risk was equivalent in men (85%) and women (82%).
HIV risk perception did not affect condom use. Almost all women (96%) and a large majority of men (83%) reported inconsistent condom use during vaginal sex. Female and male rates of inconsistent condom use during anal sex and oral sex were 89% and 81%, and 90% and 94%. Notably, 48 men (20.5%) and 26 women (21%) in this heterosexual group reported anal sex.
Most study participants--84% of men and 82% of women--said they would take a pill for PrEP. Three quarters of men and women reported they would use PrEP 1 hour before sex, or once a week, or 1 day before sex. But just under two thirds said they would take PrEP once a day, the dosing frequency studied so far [2-4].
Multivariate analysis determined that people with some high school education or less were 5 times more likely than those with more education to have no interest in PrEP (adjusted odds ratio [AOR] 4.97, 95% confidence interval [CI] 1.26 to 19.67, P = 0 .02). Low perception of HIV risk almost tripled the likelihood of having no interest in PrEP, though this association fell short of statistical significance (AOR 2.85, 95% CI 0.93 to 8.16, P = 0.10).
The researchers called for "enhanced interventions . . . to improve HIV risk perception, safer sex practices and knowledge about PrEP."
References
1. Khawcharoenporn T, Kendrick S, Smith K. Human immunodeficiency virus risk perception and interest in pre-exposure prophylaxis among persons visiting a sexually-transmitted infection clinic in Chicago. 51st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). September 17-20, 2011. Chicago. Abstract H1-1148.
2. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2011;363:2587-2799.
3. Baeten J, Celum C. Antiretroviral pre-exposure prophylaxis for HIV-1 prevention among heterosexual African men and women: the Partners PrEP study. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract MOAX0106.
4. Thigpen MC, Kebaabetswe PM, Smith DK, et al. Daily oral antiretroviral use for the prevention of HIV infection in heterosexually active young adults in Botswana: results from the TDF2 study. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract WELBC01.
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