Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers

Abstract

Introduction. 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 an objective used to objectively assess HIV risk aligned with how YMSM conceptualize their risk for HIV, and the factors that shape YMSM's risk perceptions.Methods. Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24, 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. Results.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, 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 (e.g., U=U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment. Conclusions.Quantitative assessments of risk may poorly align with risk perception among YMSM. While 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 disconnect between objective HIV risk assessments and YMSM's constructions of risk.

Routine, Opt-Out, Emergency Department Syphilis Testing Increases HIV Preexposure Prophylaxis Uptake

“…This study found that almost a quarter of the patients diagnosed with syphilis through routine ED screening started PrEP, whereas none of those without syphilis did, despite more than half of this latter group's survey answers indicating that they should be recommended PrEP 5 . Previous studies have suggested that low perceived risk is a major barrier to PrEP uptake, even in individuals reporting behaviors that increase HIV risk 2–4 . Although it is difficult to know if the participants in the present study already perceived their HIV risk to be high before their syphilis diagnosis, at the time of participation in the study, a much higher proportion of patients with syphilis perceived their HIV risk to be moderate to large compared with syphilis-negative patients with PrEP indications (16.2% vs. 7.1%).…”

“…5 Previous studies have suggested that low perceived risk is a major barrier to PrEP uptake, even in individuals reporting behaviors that increase HIV risk. [2][3][4] Although it is difficult to know if the participants in the present study already perceived their HIV risk to be high before their syphilis diagnosis, at the time of participation in the study, a much higher proportion of patients with syphilis perceived their HIV risk to be moderate to large compared with syphilis-negative patients with PrEP indications (16.2% vs. 7.1%). Furthermore, participants with syphilis were more than 3 times as likely to state that they might, probably, or definitely would start PrEP in the next 6 months (49.0% vs. 14.9%).…”

“…1 Many people who would benefit from PrEP do not perceive themselves to be vulnerable to HIVand may not initiate treatment even if recommended. [2][3][4] A diagnosis of syphilis or other bacterial sexually transmitted infection (STI) is considered an indicator of elevated risk for HIV infection, and as such, the Centers for Disease Control and Prevention (CDC) recommends HIV PrEP for any HIV-negative individuals diagnosed with a bacterial STI. 5 The emergency department (ED) has increasingly been recommended as a location for public health interventions such as HIV screening.…”

“…However, identifying people vulnerable to HIV to start and continue PrEP has been an ongoing challenge 1 . Many people who would benefit from PrEP do not perceive themselves to be vulnerable to HIV and may not initiate treatment even if recommended 2–4 . A diagnosis of syphilis or other bacterial sexually transmitted infection (STI) is considered an indicator of elevated risk for HIV infection, and as such, the Centers for Disease Control and Prevention (CDC) recommends HIV PrEP for any HIV-negative individuals diagnosed with a bacterial STI 5…”

Eligibility criteria vs. need for pre-exposure prophylaxis: a reappraisal among men who have sex with men in Amsterdam, the Netherlands

“…Unprotected exposure to multiple partners during group sex is a plausible scenario, especially when also involving chemsex [ 22 ]. Moreover, younger MSM have been identified as a potentially vulnerable group for HIV-infection due to their relatively large sexual networks and relative unawareness of sexual behaviours associated with increased STI/HIV risk [ 23 ]. It could be helpful to additionally apply these determinants as co-indicators for PrEP eligibility.…”