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Rates of new HIV infections continue to increase worldwide among men who have sex with men (MSM). Despite effective prevention strategies such as condoms and pre-exposure prophylaxis (PrEP), low usage of both methods in many parts of the world hinder prevention efforts. An individual’s perceptions of the risk of acquiring HIV and the seriousness they afford to seroconversion are important drivers of behavioral risk-taking. Understanding the behavioral factors suppressing the uptake of HIV prevention services is a critical step in informing strategies to improve interventions to combat the ongoing HIV pandemic among MSM.
The study aimed to examine cross-national perceptions of HIV/AIDS seriousness, risk, and threat and the association between these perceptions and sociodemographic characteristics, relationships, and high-risk sexual behaviors among MSM.
Participants in Australia, Brazil, Canada, Thailand, South Africa, the United Kingdom, and the United States were recruited for a self-administered survey via Facebook (N=1908). Respondents were asked to rate their perceived seriousness from 1 (not at all serious) to 5 (very serious) of contracting HIV, their perceived risk from 1 (no risk) to 10 (very high risk) of contracting HIV based on their current behavior, and their perception of the threat of HIV—measured as their confidence in being able to stay HIV-negative throughout their lifetimes—on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). Covariates included sociodemographic factors, sexual behavior, HIV testing, drug use, and relationship status. Three ordered logistic regression models, one for each outcome variable, were fit for each country.
Contracting HIV was perceived as serious (mean=4.1-4.6), but perceptions of HIV risk (mean=2.7-3.8) and threat of HIV (mean=1.7-2.2) were relatively low across countries. Older age was associated with significantly lower perceived seriousness of acquiring HIV in five countries (Australia: odds ratio, OR 0.97, 95% CI 0.94-0.99; Brazil: OR 0.95, 95% CI 0.91-0.98; Canada: OR 0.96, 95% CI 0.93-0.98; South Africa: OR 0.96, 95% CI 0.94-0.98; United Kingdom: OR 0.95, 95% CI 0.92-0.98). Being in a male-male sexual relationship was associated with significantly lower perceived risk of HIV in four countries (Australia: OR 0.47, 95% CI 0.30-0.75; Canada: OR: 0.54, 95% CI 0.35-0.86; United Kingdom: OR 0.38, 95% CI 0.24-0.60; United States: OR 0.5, 95% CI 0.31-0.82). Drug use in the previous year was associated with greater threat of contracting HIV in two countries (Canada: OR 1.81, 95% CI 1.13-2.91; United Kingdom: OR 1.7, 95% CI 1.06-2.74).
Few measures of behavioral or sexual risk-taking were significantly associated with perceived HIV seriousness, risk, or threat across countries. Overall, low levels of reported risk were identified, and results illustrate important gaps in the understanding of risk among MSM across societies that could be addressed through culturally-tailored prevention messaging.
Although new HIV infections are stable or decreasing among other risk groups, incident infections continue to increase among men who have sex with men (MSM) in the United States [
Several theories focused on understanding HIV-related risk behaviors such as the Health Belief Model and the Theory of Planned Behavior, which assert that perceptions of HIV susceptibility severity drive HIV-negative individuals’ motivations to use HIV prevention methods [
Participants were recruited online for a self-administered survey. Banner ads were placed on Facebook and displayed to men who indicated an interest in men only on their profiles and reported living in Australia, Brazil, Canada, South Africa, Thailand, the United Kingdom, or the United States. These countries were selected because of their large populations of self-identified gay and bisexual men on Facebook and to allow comparisons across socioeconomic and cultural contexts. Clicking on the advertisement led potential participants to information regarding the survey. After obtaining electronic informed consent, participants were presented with the eligibility screener that affirmed that the participants were born male, were over 18 years old, and self-reported anal or oral sex with a man in the previous year. Except for the Brazilian and Thai surveys, which were administered in Portuguese and Thai, respectively, all surveys were administered in English. Ads were displayed until 500 men in each country were recruited (range= 5 days (United States) to 14 days (Thailand)). The study was approved by the Institutional Review Board (IRB determination IRB00047677).
A total of 11,850 people across the seven sample countries clicked on the advertisement and were exposed to the eligibility screener. Of these, 58.01% (6874/11,850) began the eligibility screener; 13.09% (1551/11,850) did not meet eligibility criteria and were disqualified from completion. Among the 5323 eligible participants, 54.27% (2889/5323) men completed the survey. Of the men who completed the survey, 6.44% (186/2889) reported being HIV-positive and 27.52% (795/2889) had never been tested for HIV. Thus, they did not meet the criteria for this analysis of being known to be HIV-negative. A final convenience sample of 1908 participants who met all eligibility criteria provided data for all covariates of interest and was included in the analysis.
The anonymous survey took approximately 30 minutes to complete and collected information on participants’ sociodemographic characteristics (including age; race, ethnicity, or ancestry; and level of education). Age of sexual debut with a man was self-reported as the age at which the respondent first had sex (type of sex not defined) with a man; drug use was assessed by asking whether respondents had used any nonprescription drugs in the previous 12 months. Relationship status was determined by asking respondents whether they were currently in a sexual relationship and whether that relationship was with a man. Participants self-reported whether they had ever had an HIV test; respondents answering affirmatively were asked the date of their last HIV test. To evaluate the percentage of all condomless anal intercourse (CAI) engaged in by respondents in the previous year and the percentage of lifetime anal sex partners encountered in the previous year, respondents were asked the numbers of male anal sex partners and condomless male anal sex partners they had had intercourse with in the past 12 months and in their lifetimes.
The outcome variables were developed specifically for this survey from a review of the literature that highlighted three distinct domains of risk perception: perception of the seriousness of HIV, perception of the risk of acquiring HIV based on current behavior, and perception of the ability to remain HIV negative. The authors then developed simple scale items designed to address each of these domains. To measure perceptions of HIV seriousness, respondents were asked to rate their perception of the seriousness of contracting HIV (“How serious for you would it be if you contracted HIV?”) on a scale from 1 (not at all serious) to 5 (very serious), their perception of the risk of contracting HIV based on their current behavior (“How would you rate your risk for contracting HIV based on your current behavior?”) on a scale from 1 (no risk) to 10 (very high risk), and their perception of the threat of HIV (“How confident are you that you can stay HIV-negative in your lifetime?”) on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). These three questions provide three outcome variables measuring (1) the perceived seriousness of contracting HIV, (2) the perceived risk of contracting HIV, and (3) the perceived threat of HIV. Respondents were not compensated for completing the survey.
Data were cleaned and analyzed using Stata version 12 (StataCorp, 2012). As respondents were asked to rate their perceived risk, seriousness, and threat of contracting HIV in the future, only participants reporting having ever been tested for HIV and having had a known HIV-negative status were included in the analysis. The key sociodemographic covariates included age; education, which was dichotomized as receiving a secondary school education or less (≤12 years) or receiving higher education (>12 years); race, categorized as nonminority race or ethnicity (Australia: European, Brazil: white, Canada: European, South Africa: black, Thailand: Thai, United Kingdom: white, and United States: white) or minority race or ethnicity (Australia: other; Brazil: mixed, brown, or Other; Canada: Other; South Africa: white or other; Thailand: other; United Kingdom: black or other; United States: black or other), and drug use in the previous 12 months. Currently being in a sexual relationship was dichotomized as being in a relationship with a man versus being single.
Covariates measuring sexual behaviors included age of sexual debut with a man; percentage of condomless versus all anal intercourse partners encountered in the previous year, which was calculated by dividing respondents’ reported number of CAIpartners in the previous year by the reported number of all anal intercourse partners in the previous year; and percent of lifetime anal sex partners encountered in the previous year, which was calculated by dividing the reported number of anal sex partners in the previous year by the total number of lifetime anal sex partners. Time since respondents’ last HIV test was calculated in years by subtracting the month and year of survey completion from the reported month and year of respondents’ last HIV test. Given the ordinal outcomes of perceived HIV seriousness, risk, and threat, the analysis employed ordered logistic regression models. In order to make cross-country comparisons of the outcome variables, separate models were fitted for each of the three outcomes in each of the seven countries. This required separate datasets for each country, fitting three models per dataset.
Demographic characteristics of the sample, respondents’ sexual behaviors, time since respondents’ last HIV test, and perceived seriousness, risk, and threat of HIV seroconversion are summarized in
Across all the countries, between 50.2%-63.8% of respondents’ anal sex partners in the previous year were condomless, and less than 1/3 of respondents’ anal intercourse partners had been encountered in the previous year. Time since respondents’ most recent HIV test ranged from 1.2 (South Africa) to 2.3 (Thailand and the United Kingdom) years.
Country-specific mean perceived seriousness of contracting HIV ranged from 4.1 (SD=0.1) in Thailand to 4.7 (SD=0.9) in the United States (see
Respondent age was negatively associated with perceived HIV seriousness in all countries except Thailand and the United States. Age was negatively associated with perceived risk in the United States. There was a significant, positive association between education and perceived HIV seriousness, risk, and threat in two countries. Compared to respondents with less than or equal to 12 years of education, respondents with more than 12 years of education had significantly greater odds of perceiving a higher HIV seriousness in the United Kingdom and a higher HIV risk and threat in Canada. Moreover, in Canada, respondents belonging to minority races had significantly lower odds of perceiving a higher HIV seriousness than respondents belonging to nonminority races. South African respondents belonging to a minority race had significantly lower odds of perceiving a higher HIV risk and HIV threat than those belonging to a nonminority race.
Respondent characteristics and mean minority stress scale index scores of 1891 internet-recruited men who have sex with men in seven countries.
Variable | Australia |
Brazil |
Canada |
South Africa |
Thailand |
United |
United |
|
Age in years | 30.4 (11.5) | 25.8 (7.7) | 33.9 (12.6) | 33.2 (10.3) | 32.3 (7.8) | 30.6 (11.2) | 30.9 (13.4) | |
≤12 years | 103 (37.6) | 97 (33.0) | 64 (23.4) | 118 (30.6) | 22 (15.1) | 62 (22.1) | 71 (28.0) | |
>12 years | 171 (62.4) | 197 (67.0) | 210 (76.6) | 268 (69.4) | 124 (84.9) | 218 (77.9) | 183 (72.1) | |
Nonminority | 168 (61.3) | 189 (64.3) | 219 (79.9) | 56 (14.5) | 138 (94.5) | 266 (95.0) | 207 (81.5) | |
Minority | 106 (38.7) | 105 (35.7) | 55 (20.1) | 330 (85.5) | 8 (5.5) | 14 (5.0) | 47 (18.5) | |
No | 153 (55.8) | 203 (69.1) | 145 (52.9) | 233 (60.4) | 112 (76.7) | 179 (63.9) | 162 (63.8) | |
Yes | 121 (44.2) | 91 (30.9) | 129 (47.1) | 153 (39.6) | 34 (23.3) | 101 (36.1) | 92 (36.2) | |
Single | 130 (47.5) | 150 (51.0) | 107 (39.1) | 165 (42.8) | 60 (41.1) | 122 (43.6) | 118 (46.5) | |
In a relationship | 144 (52.6) | 144 (49.0) | 167 (60.9) | 221 (57.3) | 86 (58.9) | 158 (56.4) | 136 (53.5) | |
Age of sexual debut with a man | 17.5 (4.7) | 15.2 (3.9) | 17.4 (5.0) | 17.1 (4.6) | 17.9 (4.4) | 17.5 (4.6) | 17.1 (4.8) | |
Percentage of unprotected versus all anal intercourse partners in previous year | 54.7 (42.8) | 50.2 (41.2) | 54.4 (43.9) | 63.8 (42.5) | 54.0 (43.7) | 55.9 (43.2) | 61.1 (43.7) | |
Percentage of lifetime anal sex partners encountered in previous year | 26.5 (29.5) | 30.1 (29.3) | 25.6 (29.3) | 26.3 (25.7) | 35.0 (33.6) | 28.1 (29.3) | 31.8 (34.0) | |
Years since most recent HIV test | 1.4 (2.5) | 1.4 (1.9) | 1.7 (2.6) | 1.2 (1.9) | 2.3 (2.7) | 2.3 (4.1) | 1.5 (2.7) | |
Perceived seriousness of contracting HIV (1-10) | 4.6 (0.9) | 4.6 (0.9) | 4.6 (1.0) | 4.3 (1.1) | 4.1 (0.1) | 4.6 (0.9) | 4.7 (0.9) | |
Perceived risk of contracting HIV (1-5) | 2.9 (2.1) | 3.2 (2.4) | 2.7 (2.1) | 3.0 (2.4) | 3.8 (0.2) | 2.8 (2.1) | 3.0 (2.3) | |
Perceived inability to stay HIV-negative throughout life (1-10) | 1.8 (1.0) | 2.1 (1.1) | 1.7 (0.9) | 1.8 (1.0) | 2.2 (0.1) | 1.7 (0.9) | 1.8 (1.0) |
aNon-minority race/ethnicity was categorized as follows: Australia: European, Brazil: white, Canada: European, South Africa: black, Thailand: Thai, United Kingdom: white, United States: white. Minority race/ethnicity was categorized as follows: Australia: Other; Brazil: Mixed, brown, and Other; Canada: Other; South Africa: white and Other; Thailand: Other; United Kingdom: black and Other; United States: black and Other.
Adjusted Odds Ratios and 95% CIs between perceived HIV seriousness and respondent characteristics.
Variable | Australia |
Brazil |
Canada |
South Africa |
Thailand |
United |
United |
Age in years | 0.97 (0.94-0.99)a | 0.95 (0.91-0.98)a | 0.96 (0.93-0.98)a | 0.96 (0.94-0.98)a | 0.97 (0.93-1.01) | 0.95 (0.92-0.98)a | 0.98 (0.95-1.01) |
≤12 years of education (ref: >12 years) | 1.21 (0.65-2.28) | 0.95 (0.53-1.71) | 0.64 (0.29-1.43) | 0.85 (0.52-1.39) | 1.84 (0.71-4.77) | 1.94 (1.02-3.71)a | 0.94 (0.45-1.92) |
Minority race (ref: nonminority race) | 1.11 (0.59-2.09) | 1.15 (0.65-2.02) | 0.4 (0.19-0.82)a | 1.3 (0.67-2.51) | 0.4 (0.09-1.72) | 1.3 (0.34-4.97) | 0.79 (0.34-1.83) |
Drug use in previous 12 months (ref: no drug use) | 0.88 (0.47-1.66) | 0.84 (0.48-1.45) | 1.44 (0.76-2.72) | 1.07 (0.68-1.69) | 0.9 (0.41-1.97) | 0.49 (0.28-0.87)a | 0.86 (0.44-1.67) |
In a relationship (ref: single) | 1.17 (0.61-2.24) | 0.8 (0.47-1.34) | 1.03 (0.52-2.02) | 0.64 (0.4-1.03) | 0.48 (0.24-0.98)a | 0.84 (0.47-1.51) | 1.26 (0.62-2.56) |
Age of sexual debut with a man | 1.08 (1.01-1.16)a | 1.02 (0.95-1.08) | 1.09 (1.02, 1.17a | 1.02 (0.97-1.07) | 1.01 (0.93-1.1) | 1.04 (0.98-1.11) | 0.98 (0.92-1.04) |
Percentage of unprotected versus all anal intercourse partners in previous year | 0.87 (0.4-1.88) | 0.92 (0.49-1.75) | 0.93 (0.44-1.96) | 1.76 (1.02-3.05)a | 1.65 (0.74-3.7) | 1.5 (0.76-2.94) | 0.63 (0.28-1.45) |
Percentage of lifetime anal sex partners encountered in previous year | 1.8 (0.45-7.25) | 0.76 (0.32-1.8) | 4.38 (0.85-22.56) | 1.33 (0.5-3.58) | 1.73 (0.57-5.28) | 1.62 (0.47-5.56) | 1.3 (0.41-4.13) |
Years since most recent HIV test | 1 (0.9-1.12) | 1.08 (0.94- 1.24) | 1.04 (0.91-1.18) | 0.96 (0.87-1.07) | 0.97 (0.87-1.09) | 1.08 (1.01-1.15)a | 0.93 (0.83-1.05) |
aStatistical significance, alpha=.05.
Adjusted Odds Ratios and 95% CIs between perceived HIV risk and respondent characteristics.
Variable | Australia |
Brazil |
Canada |
South Africa |
Thailand |
United |
United |
Age in years | 0.98 (0.96-1) | 1 (0.97-1.03) | 1 (0.98, 1.02) | 1.01 (0.99-1.03) | 0.97 (0.94-1.01) | 1 (0.97-1.03) | 0.97 (0.95-0.99)a |
≤12 years of education (ref: >12 years) | 0.75 (0.48-1.18) | 1.17 (0.74-1.84) | 1.83 (1.06, 3.16)a | 1.3 (0.87-1.96) | 0.77 (0.34-1.73) | 1.31 (0.74-2.33) | 1.55 (0.92-2.62) |
Minority race (ref: nonminority race) | 1.24 (0.78-1.95) | 1.18 (0.76-1.81) | 1.37 (0.79, 2.39) | 0.53 (0.3-0.91)a | 0.49 (0.14-1.71) | 0.69 (0.26-1.85) | 0.75 (0.4-1.37) |
Drug use in previous 12 months (ref: no drug use) | 1.36 (0.86-2.14) | 1.39 (0.89-2.16) | 2.6 (1.67, 4.05)a | 1.78 (1.22-2.58)a | 1.77 (0.88-3.55) | 2.23 (1.41-3.52)a | 1.85 (1.16-2.95)a |
In a relationship (ref: single) | 0.47 (0.3-0.75)a | 0.73 (0.48-1.11) | 0.54 (0.35, 0.86)a | 0.75 (0.51-1.1) | 1.31 (0.7-2.42) | 0.38 (0.24-0.6)a | 0.5 (0.31-0.82)a |
Age of sexual debut with a man | 0.95 (0.9-0.99)a | 0.94 (0.9-1)a | 1 (0.96, 1.05) | 0.99 (0.95-1.03) | 1.06 (0.98-1.15) | 1 (0.95-1.05) | 1 (0.95- 1.05) |
Percentage of unprotected versus all anal intercourse partners in previous year | 0.65 (0.37-1.12) | 0.5 (0.3-0.84)a | 0.9 (0.53, 1.53) | 0.69 (0.44-1.1) | 0.98 (0.48-2.01) | 0.67 (0.4-1.12) | 1.07 (0.6-1.89) |
Percentage of lifetime anal sex partners encountered in previous year | 1.05 (0.45-2.43) | 1.33 (0.67-2.66) | 1.28 (0.56, 2.92) | 1.99 (0.91-4.34) | 0.86 (0.35-2.09) | 1.65 (0.71-3.8) | 1.04 (0.48-2.27) |
Years since most recent HIV test | 0.93 (0.83-1.04) | 1.06 (0.95-1.19) | 0.95 (0.87, 1.05) | 0.94 (0.86-1.04) | 1.18 (1.05-1.31)a | 0.92 (0.87-0.98)a | 1 (0.9-1.1) |
aStatistical significance at alpha=.05.
There was a significant negative association between drug use and perceived HIV seriousness in the United Kingdom. Conversely, there was a significant positive association between drug use and perceived HIV risk in Canada, South Africa, the United Kingdom, and the United States and between drug use and threat of HIV in Canada and the United Kingdom.
Reporting a current sexual relationship with a man was negatively associated with perceived HIV seriousness (Thailand), risk (Australia, Canada, the United Kingdom, and the United States), and threat (Australia) in several countries. As compared with those not in a male-male relationship, respondents reporting currently being in a sexual relationship had significantly lower odds of perceiving a higher HIV seriousness in Thailand; significantly lower odds of perceiving a higher risk of HIV in Australia, Brazil, Canada, the United Kingdom, and the United States; and significantly lower odds of perceiving a higher threat of HIV in Australia.
Age of sexual debut with a man was positively associated with perceived seriousness of HIV in two countries and negatively associated with perceived risk of HIV in two countries. As age of sexual debut with a man increased, the odds of perceiving a higher seriousness of HIV increased significantly in Australia and Canada, while the odds of perceiving a higher HIV risk significantly decreased in Australia and Brazil. As the percentage of condomless anal intercourse partners in the previous year increased, the odds of perceiving a higher HIV risk significantly decreased in Brazil and the odds of perceiving a higher HIV threat significantly decreased in Brazil and South Africa. The percent of lifetime anal sex partners encountered in the previous year was associated with only one outcome (HIV threat) in one country. In the United States, the odds of perceiving a higher HIV threat significantly decreased as the percentage of lifetime anal sex partners encountered in the previous year increased. Time since last HIV test was positively associated with perceived HIV seriousness in the United Kingdom. The association between time since last HIV test and perceived HIV risk yielded mixed results. As time since respondents’ last HIV test increased, odds of perceiving a higher HIV risk increased significantly among participants in Thailand, but decreased significantly among participants in the United Kingdom.
Adjusted Odds Ratios and 95% CIs between perceived HIV threat and respondent characteristics.
Variable | Australia |
Brazil |
Canada |
South Africa |
Thailand |
United |
United |
Age in years | 0.99 (0.96-1.01) | 1.02 (0.98-1.05) | 1 (0.98-1.03) | 1.01 (0.99-1.03) | 0.99 (0.95-1.03) | 1.02 (0.99-1.04) | 0.99 (0.97-1.01) |
≤12 years of education (ref: >12 years) | 0.87 (0.54-1.42) | 1.29 (0.81-2.05) | 2.27 (1.23-4.19)a | 1.37 (0.89-2.1) | 0.46 (0.19-1.11) | 1.06 (0.58-1.94) | 1.31 (0.75-2.27) |
Minority race (ref: nonminority race) | 1.2 (0.74-1.94) | 0.74 (0.47-1.16) | 0.83 (0.45-1.54) | 0.53 (0.3-0.95)a | 2.17 (0.59-7.88) | 1.06 (0.37-3.01) | 1.55 (0.82-2.92) |
Drug use in previous 12 months (ref: no drug use) | 1.42 (0.87-2.31) | 1.33 (0.84-2.12) | 1.81 (1.13-2.91)a | 1.4 (0.94-2.08) | 1.22 (0.6-2.51) | 1.7 (1.06-2.74)a | 0.9 (0.55-1.48) |
In a relationship (ref: single) | 0.55 (0.34-0.89)a | 0.75 (0.49-1.16) | 0.84 (0.51-1.38) | 0.94 (0.63-1.4) | 1.15 (0.6-2.2) | 0.7 (0.44-1.11) | 0.78 (0.46-1.32) |
Age of sexual debut with a man | 0.98 (0.93-1.04) | 0.98 (0.93-1.03) | 0.98 (0.93-1.03) | 1 (0.96-1.04) | 1.05 (0.97-1.13) | 1 (0.95-1.05) | 1 (0.95-1.06) |
Percentage of unprotected versus all anal intercourse partners in previous year | 0.74 (0.41-1.34) | 0.54 (0.32-0.93)a | 0.89 (0.5-1.58) | 0.52 (0.32-0.84)a | 1.4 (0.67-2.94) | 0.81 (0.47-1.41) | 0.55 (0.3-1.02) |
Percentage of lifetime anal sex partners encountered in previous year | 0.65 (0.26-1.61) | 1.21 (0.59-2.49) | 1.11 (0.43-2.87) | 1.2 (0.52-2.76) | 1.17 (0.45-2.99) | 0.96 (0.38-2.42) | 0.36 (0.15-0.87)a |
Years since most recent HIV test | 1.03 (0.92-1.15) | 1 (0.89-1.13) | 0.98 (0.89-1.08) | 0.97 (0.88-1.07) | 1.08 (0.97-1.21) | 0.94 (0.88-1.01) | 0.92 (0.82-1.03) |
aStatistical significance at alpha=.05.
The results of this study point to the potential influence of drug use, relationships, and age on individual reporting of perceived HIV seriousness, risk of HIV seroconversion, and lifetime threat of HIV seroconversion among MSM across culturally and economically diverse settings. While some cross-national trends were found, the variations across countries point to the importance of cultural context in understanding the drivers of perceived risk of HIV.
Respondents reporting currently being in a sexual relationship with a man perceived a lower risk of contracting HIV compared to respondents not in a relationship. This may be the result of messaging to MSM regarding HIV risk. Since the beginning of the epidemic, HIV prevention messaging has focused on the risks associated with having multiple concurrent sexual partners. However, recent evidence suggests that between one-third [
Older respondents reported a significantly lower perceived seriousness (five countries) and risk (US) of contracting HIV or AIDS than younger respondents. These results may reflect some degree of treatment optimism; largely as a result of highly active anti-retroviral treatment (HAART), HIV-positive MSM are living longer than they were twenty years ago. Although the sample is of HIV-negative men, these men may have observed the changes in the impact of HIV on those living with it, —and the transformation of HIV into manageable chronic condition. This may allow them to perceive the threat of HIV as less serious now than in the past. The prevalence of HIV and AIDS among older MSM is higher than among young MSM in many places [
Few measures of recent sexual behavior were significantly associated with perceived HIV seriousness, risk, or threat across multiple countries. An older age of sexual debut with a man was associated with a higher perceived HIV seriousness (Australia and Canada) and lower perceived HIV risk (Australia and Brazil). It is possible that a higher perceived seriousness of HIV actually delayed participants’ sexual debut. An earlier age of sexual debut has been associated with engaging in sexual risk behaviours and positive HIV status [
There are limitations to the present study, most of which result from the Web-based convenience sampling design. In all countries, the survey was advertised only to men who were registered users of Facebook and had a profile indicating an interest in men, leading to selection bias towards men who may be more public about their sexual identity or behavior. A recent study reported that Web-based recruitment and venue-based recruitment yields similar samples of MSM in the United States [
Perceived risks of HIV infection were generally low across MSM in this international sample. Across countries, older MSM and those in sexual relationships perceived themselves to have lower risk and threat of HIV, while drug using MSM perceived their HIV risk as higher. Few measures of sexual behavior were associated with perceptions of HIV seriousness, risk, or threat. Our results point to the need for more nuanced research into the constructs of risk perception among MSM. Currently, little is known about how risk perception varies with age, stage of life, or the availability of new biomedical preventative options such as PrEP. Among MSM internationally, varying sociopolitical climates and the relative strength of structural minority stressors such as heteronormative social pressure and homophobic discrimination may also have important effects. A more cogent understanding of the constructs associated with HIV risk perception may lead to more tailored and effective HIV prevention interventions for MSM. The results also suggest that, while existing HIV prevention messages continue to focus on the HIV risks of condomless sex, such messages may need to be packaged differently for men in relationships and for older men. Additionally, novel strategies to help MSM understand the true risks of unsafe sex and to surmount the effects of behavioral discordance are still needed.
acquired immune deficiency syndrome
condomless anal intercourse
couples HIV counseling and testing
highly active anti-retroviral treatment
human immunodeficiency virus
men who have sex with men
adjusted Odds Ratio
None declared.