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Research article
Robin Schaefer
Imperial College London
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4733-4692
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Perceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception.
Methods: Data on sexually active, HIV-negative adults (15-54 years) were taken from four surveys of a general-population open-cohort study in Manicaland, Zimbabwe (2003-2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bi-directional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated.
Results: 1988 males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio aOR=1.39, 95% confidence interval CI=0.85-2.28, PAF=3.39%; females: aOR=1.41 1.06-1.88, PAF=6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR=1.76 1.12-2.78; females: aOR=1.23 0.93-1.62).
Conclusions: Results on associations between changing risk perception and increasing condom use support hypothesised effects of risk perception on condom use and effects of condom use on risk perception (down-adjusting risk perception after adopting condom use). However, low proportions of change in condom use were attributable to changing risk perception, underlining the range of factors influencing HIV prevention behaviour and the need for comprehensive approaches to HIV prevention.
Keywords
HIV prevention; condom use; risk perception; Zimbabwe
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CURRENT STATUS: Published
View the published article at BMC Public Health.
No community comments so far
Editorial decision: Accept
On 30 Apr, 2020
Reviewer #1 agreed
On 28 Apr, 2020
Editor assigned
On 27 Apr, 2020
Reviewers invited
Invitations sent on 27 Apr, 2020
Submission checks complete
On 26 Apr, 2020
Editor invited
On 26 Apr, 2020
No comments provided
Editorial decision: Major revision
On 20 Apr, 2020
Review #2 received
Received 14 Mar, 2020
Review #1 received
Received 02 Mar, 2020
Reviewer #1 agreed
On 25 Feb, 2020
Reviewer #2 agreed
On 25 Feb, 2020
Editor assigned
On 24 Feb, 2020
Reviewers invited
Invitations sent on 24 Feb, 2020
Submission checks complete
On 23 Feb, 2020
Editor invited
On 23 Feb, 2020
No comments provided
Editorial decision: Major revision
On 19 Feb, 2020
Review #1 received
Received 09 Feb, 2020
Review #2 received
Received 02 Feb, 2020
Reviewer #2 agreed
On 24 Jan, 2020
Reviewer #1 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 12 Nov, 2019
Editor assigned
On 15 Oct, 2019
Submission checks complete
On 14 Oct, 2019
Editor invited
On 14 Oct, 2019
Version 1
Posted 30 Jul, 2019
No comments provided
Reviewer #1 agreed
On 25 Sep, 2019
Review #1 received
Received 25 Sep, 2019
Editorial decision: Minor revision
On 25 Sep, 2019
Reviewers invited
Invitations sent on 09 Aug, 2019
Submission checks complete
On 25 Jul, 2019
Editor assigned
On 22 Jul, 2019
Editor invited
On 21 Jul, 2019
First submitted
On 17 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
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A new preprint design is coming!
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See the published version of this preprint at BMC Public Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Robin Schaefer
Imperial College London
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4733-4692
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Public Health.
No community comments so far
Editorial decision: Accept
On 30 Apr, 2020
Reviewer #1 agreed
On 28 Apr, 2020
Editor assigned
On 27 Apr, 2020
Reviewers invited
Invitations sent on 27 Apr, 2020
Submission checks complete
On 26 Apr, 2020
Editor invited
On 26 Apr, 2020
No comments provided
Editorial decision: Major revision
On 20 Apr, 2020
Review #2 received
Received 14 Mar, 2020
Review #1 received
Received 02 Mar, 2020
Reviewer #1 agreed
On 25 Feb, 2020
Reviewer #2 agreed
On 25 Feb, 2020
Editor assigned
On 24 Feb, 2020
Reviewers invited
Invitations sent on 24 Feb, 2020
Submission checks complete
On 23 Feb, 2020
Editor invited
On 23 Feb, 2020
No comments provided
Editorial decision: Major revision
On 19 Feb, 2020
Review #1 received
Received 09 Feb, 2020
Review #2 received
Received 02 Feb, 2020
Reviewer #2 agreed
On 24 Jan, 2020
Reviewer #1 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 12 Nov, 2019
Editor assigned
On 15 Oct, 2019
Submission checks complete
On 14 Oct, 2019
Editor invited
On 14 Oct, 2019
Version 1
Posted 30 Jul, 2019
No comments provided
Reviewer #1 agreed
On 25 Sep, 2019
Review #1 received
Received 25 Sep, 2019
Editorial decision: Minor revision
On 25 Sep, 2019
Reviewers invited
Invitations sent on 09 Aug, 2019
Submission checks complete
On 25 Jul, 2019
Editor assigned
On 22 Jul, 2019
Editor invited
On 21 Jul, 2019
First submitted
On 17 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Public Health.
Background: Perceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception.
Methods: Data on sexually active, HIV-negative adults (15-54 years) were taken from four surveys of a general-population open-cohort study in Manicaland, Zimbabwe (2003-2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bi-directional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated.
Results: 1988 males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio aOR=1.39, 95% confidence interval CI=0.85-2.28, PAF=3.39%; females: aOR=1.41 1.06-1.88, PAF=6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR=1.76 1.12-2.78; females: aOR=1.23 0.93-1.62).
Conclusions: Results on associations between changing risk perception and increasing condom use support hypothesised effects of risk perception on condom use and effects of condom use on risk perception (down-adjusting risk perception after adopting condom use). However, low proportions of change in condom use were attributable to changing risk perception, underlining the range of factors influencing HIV prevention behaviour and the need for comprehensive approaches to HIV prevention.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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