Risk perception of HIV infection in South Africa: A Nationally Representative Survey Authors: Patience Gamuchirai Manjengwa-Hungwe, K Mangold, M Pule, A Musekiwa, L Kuonza South African Field Epidemiology Training Programme (SAFETP) Date: 2 December 2015

HIV/AIDS burden in South Africa South Africa has a population of 54 million people 6.4 million (12%) estimated to be living with HIV infection An estimated new HIV infections were recorded during 2012

HIV prevention strategies Many interventions have been implemented to reduce HIV transmission In South Africa a national social & behavioural change communication strategy was developed Perception of risk of HIV infection is one of core constructs used in evaluating behaviour change in population People who perceive themselves to be at ‘low risk’ of HIV infection have high likelihood of acquiring HIV infection

Objectives of the study Determine the risk perceptions regarding HIV infection in the South Africa population Identify factors contributing to risk perception regarding HIV infection.

Methods – Study population Used data from a South African National HIV Communication Survey conducted in 2012 –Nationally representative sample –Recruited 9,728 respondents –Multi-stage stratified random cross-sectional design The survey questionnaire enquired about: –risk perception regarding HIV infection –condom use –number of sexual partners –HIV testing 12 months prior to the survey

Methods – The Survey Questionnaire A question from the HIV knowledge, attitude and perceived risk section was used in this analysis: QuestionPossible Responses What do you think are your chances of getting infected with HIV? 1.I am definitely going to get infected with HIV 2.I am probably going to get infected with HIV 3.I probably wont get infected with HIV 4.I will definitely not get infected with HIV High Risk Perception

Methods – The Survey Questionnaire A question from the HIV knowledge, attitude and perceived risk section was used in this analysis: QuestionPossible Responses What do you think are your chances of getting infected with HIV? 1.I am definitely going to get infected with HIV 2.I am probably going to get infected with HIV 3.I probably wont get infected with HIV 4.I will definitely not get infected with HIV Low Risk Perception

Methods – The Survey Questionnaire Inclusion criteria: –We included all respondents who reported having at least one sexual encounter in the past twelve months Exclusion criteria: –We excluded all respondents who reported that they were HIV positive

Methods - Data analysis Multivariable logistic regression analysis –Manual backward stepwise procedure Outcome variables –High risk perception of HIV infection –Low risk perception of HIV infection Confounders –Age, gender

Demographic Characteristics Fig 1:Demographic characteristics of participants by risk perception of HIV infection

Risky sexual behaviours Figure 2: Description of risky sexual behaviours by risk perception

Predictors of low perceived risk of HIV infection

Predictors of high perceived risk of HIV infection PredictorsAdjusted Odds Ratio P-value Socio-Economic StatusLow1.58( )<0.001 High1 Marital statusMarried (living separate)2.47( )<0.001 Widowed/Divorced1 SettlementFarming2.00( )<0.05 Urban formal1 Self esteemLow1.67( )<0.05 High1 Multiple sexual partnershipYes2.07( )<0.001 No1

Conclusion High socio economic status, living in urban formal settlements and male gender were significant predictors of low risk perception of HIV infection Economic, behavioural and self-esteem factors were significantly associated with high risk perception of HIV infection Majority of people who engaged in risky sexual behaviours had a low perceived risk of HIV infection

Limitations Information bias due to self reported data Categorised probably as high or as low

Recommendations Initiatives on behaviour change targeted at people with low perceived risk of HIV infection. Targeted interventions are needed to raise awareness of HIV risk associated with risk sexual behaviours.

Acknowledgements National Communications Survey 2012 undertaken by Johns Hopkins Health and Education in South Africa, lovelife and Soul City and managed by Health and Development Africa South African National AIDS Council Trust (SANAC Trust) South African Field Epidemiology and Training Programme (SAFETP)

Thank You