The Rhythm of Risk: Sexual Behaviour, PrEP Use and HIV Risk Perception Between 1999 and 2018 Among Men Who Have Sex with Men in Amsterdam, The Netherlands

Abstract

HIV risk perception plays a crucial role in the uptake of preventive strategies. We investigated how risk perception and its determinants changed between 1999 and 2018 in an open, prospective cohort of 1323 HIV-negative men who have sex with men (MSM). Risk perception, defined as the perceived likelihood of acquiring HIV in the past 6 months, changed over time: being relatively lower in 2008–2011, higher in 2012–2016, and again lower in 2017–2018. Irrespective of calendar year, condomless anal intercourse (AI) with casual partners and high numbers of partners were associated with higher risk perception. In 2017–2018, condomless receptive AI with a partner living with HIV was no longer associated with risk perception, while PrEP use and condomless AI with a steady partner were associated with lower risk perception. We showed that risk perception has fluctuated among MSM in the past 20 years. The Undetectable equals Untransmittable statement and PrEP coincided with lower perceived risk.

Time for change: Transitions between HIV risk levels and determinants of behavior change in men who have sex with men

“…The increase in sexual behavior associated with high STI and HIV risk may be related to important developments in terms of HIV prevention and treatment. The introduction of biomedical interventions improving treatment and prevention of HIV, such as ART and PrEP, may have had a large impact on HIV risk perception and subsequent behavior [ 16 ]. As PrEP effectively diminishes HIV risk, HIV risk perception may decrease, which might result in increased insertive and receptive condomless AI and STI risk among PrEP users [ 10 , 14 – 16 , 34 ].…”

“…Erection stimulants and poppers were defined as using one or both of these sexual performance enhancing drugs during sex in the past six months. Perceived risk to have acquired HIV in the past six months was measured on a 7-point Likert scale from 1 ‘impossible’ to 7 ‘very high’ [ 16 ], and high HIV risk perception was defined as all scores higher than the median (score 3–7).…”

“…In addition, a steady partnership may be associated with decreasing risk, such as decreased number of partners [ 13 ]. Also, HIV risk perception is associated with sexual behavior [ 14 – 16 ]. For example, high HIV risk perception may indicate that an individual is aware of the increased HIV risk associated with their current sexual behavior.…”

The invisible influence: impact of psychological mechanisms of sexual behaviour on chlamydia transmission

“…There are many factors that influence behaviour change, and the aforementioned psychological theories that predict behaviour, such as the HBM, TRA, and TPB [45][46][47][48], can also be used to explain changes in behaviour and psychological characteristics. For example, according to the HBM, changing sexual behaviour depends on an individual's perceived susceptibility of acquiring chlamydia, perceived severity of chlamydia, perceived barriers (e.g., social, physical, or psychological barriers to condom use), perceived benefits (e.g., how effective is condom use in preventing chlamydia infections), cues to action (i.e., an internal or external cues triggering certain behaviour), and self-efficacy (e.g., an individuals' perception of his/her ability to use condoms) [111][112][113]. Another example is the information-motivation-behavioural skills model, which describes how knowledge, motivation, and behavioural skills are necessary to adopt certain behaviour, such as consistent condom use [114].…”

“…Assessing the impact of behavioural interventions on subsequent behaviour and STI transmission would be especially interesting considering that fact that high-risk HIV-negative MSM are eligible for PrEP use, a highly effective drug to prevent HIV infections that has recently become available in the Netherlands, and many other countries [107,108]. There have been concerns about an increase in insertive and receptive condomless anal intercourse among PrEP users [109][110][111], and a subsequent increase STI diagnosis. Therefore, identifying effective behavioural interventions for different types of individuals based on psychological characteristics in the MSM population may be important to reduce STI transmission among PrEP users.…”