Rethinking risk perception for HIV infection and its relation with condom use among men who have sex with men: from behavioral to interactionism perspectives
Background: Several behavioral interventions have focused on increasing risk perception for HIV infection among persons at risk of becoming infected. International studies have shown that people aware of their risk of exposure to HIV still practice unprotected sex. This study explores, among men who have sex with men (MSM):
1) their perceived risk of becoming infected based on sexual partner’s characteristics; and
2) the effect of perceived risk on condom use with casual partners.
Methods: Nine triads were conducted with MSM in Mexico City and Merida and content analysis was used to identify risk constructs among informants. A survey was conducted with 894 MSM in Mexico City, Merida, Mexicali, Veracruz and Tapachula following a time-location sampling frame and multivariate analysis was used to identify determinants of condom use at last anal sexual intercourse with a casual partner (p<0.05).
Results: In the qualitative analysis, young, good-looking and wealthy men were not perceived to be risky partners and respondents were willing to have unprotected sex with them. Logistic regression reinforces this finding. Men who reported they would not accept unprotected sex with a good-looking man were more likely to use condoms at last casual sex than men who report they would (OR= 1.69; p<0.05). Other determinants for condom use at last sexual intercourse were: Disagreeing with trust ideas (OR=1.91; p<0.001); feeling at high risk for HIV (OR=0.54; p<0.05); and having more than 4 sexual partners in the previous year (OR=2.8; p<0.001).
Conclusions: These findings suggest the challenge of including insights from social interactionism theories on HIV prevention programs. Since determinants of risk perception are closely related to the context in which sex takes place, implementation of workshops and motivational interviews is recommended to link knowledge about HIV to ideals about relationships and sexual experiences. The emphasis is not the information, but the re-cognition process achieved throughout a conversation setting.
-Abstract available at link below-