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MacKellar et al. (2007) surveyed 2,788 men who have sex with men (MSM), ages 23 to 29 years, who were attending MSM-identified venues in six US cities, regarding their perceived lifetime risk for acquiring HIV, their risk behaviors, and the results of their most recent HIV test. This last query served to identify men with unrecognized HIV infection (i.e., not reporting a positive HIV test result that was received earlier in this study). The investigators found that, "[o]verall, approximately one quarter of young MSM perceived themselves at moderate/high risk for acquiring HIV. Adjusting for demographic, prior testing, and behavioral characteristics, moderate/high perceived risk had the strongest association with unrecognized HIV infection. However, half of the 267 young MSM with unrecognized infection perceived themselves at low lifetime risk for acquiring HIV, and many young MSM with low-risk perception reported considerable risk behaviors" (p. 263). On the basis of these findings, MacKellar and colleagues suggest that
perceived lifetime risk, measured as susceptibility to HIV infection, may be a more valid and reliable predictor of actual risk (i.e., unrecognized infection) than [are] surrogate behavioral measures. Thus, to help increase testing and reduce the high prevalence of unrecognized HIV infection among young MSM, providers of HIV prevention services should consider incorporating clients' perception of HIV susceptibility within risk-assessment practices. For those men who report perceiving themselves at moderate/high risk for acquiring HIV, providers should underscore the urgency for HIV testing, and assess and resolve personal testing barriers. ... The use of rapid HIV tests ... may be a particularly effective strategy to increase testing and provision of test results to high-risk MSM ... .
... [T]o increase testing and reduce the prevalence of unrecognized HIV infection, ... providers should intensify efforts to assess and clarify HIV infection risks and perceptions of young MSM, particularly those who are black and Hispanic. ... Health-care providers should routinely recommend HIV testing for clients at increased risk for infection; HIV-test providers should routinely assess and clarify personal infection risks and encourage follow-up testing for clients with ongoing risk behaviors ... .
In providing HIV test results to clients, providers should be aware of the potential influence a negative result might have on perceived susceptibility, and subsequent behavioral and HIV-infection risks. ... [S]ome persons may underestimate current or future HIV infection risks because of tendencies to anchor perceptions on prior negative test results ... . While [these investigators] found that MSM who received a negative test result in the past year were less likely to perceive themselves at moderate/high lifetime risk and to acquire HIV ..., seven percent of these men were HIV-infected [and] unaware [of their serostatus]. ... For MSM who test HIV-negative, test providers should consider assessing what effect a negative test result might have on their client's perceived future infection risks, and if needed, counsel young MSM that a negative test result offers no assurance that they will remain free from HIV infection. (pp. 268-269)
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Summer 2007 Newsletter / Volume 8, Issue 4
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