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Condom Use Related to Perception of Local HIV Prevalence

Men’s condom usage is related to numerous factors. Among them is the accuracy of their perceptions about HIV prevalence in their community.

A new study of adult gay, bisexual and other men who have sex with men (GBMSM) shows that those who underestimate the HIV prevalence in their local community tend to exhibit higher HIV risk behaviors. For example, a man who underestimates HIV prevalence in his zip code area is 14% more likely to have had recent condomless anal intercourse (CAI) and 13% less likely to report recent HIV testing. Inversely, men who overestimate the prevalence of HIV in their community by over 10% tend to report more HIV preventive behaviors, such as using condoms and HIV testing. These findings, published last month in AIDS and Behavior, come at a time of increased public scrutiny of geographic disparities in HIV prevalence in the United States.

Researchers estimate that about 15% of GBMSM in the U.S. are HIV-positive, according to a report released last year. In metropolitan centers across the country, there are dramatic differences in prevalence of HIV diagnosis – ranging from 13% in Los Angeles to almost 40% in Jackson, Mississippi. Understanding how accurately men perceive the prevalence of HIV in their communities may inform future prevention efforts.

On average, survey participants tended to overestimate HIV prevalence in their surrounding zip code area by several percentage points. Still, their estimation of national HIV prevalence was, on average, accurate within one percentage point. Surprisingly, respondents estimated HIV prevalence to be lower among their friends and sexual partners than among the general public across the state and country.

Stephen Sullivan and Rob Stephenson, the study’s co-authors, conduct HIV prevention research at the University of Michigan’s Center for Sexuality and Health Disparities. They explained that knowledge about the HIV prevalence in one’s community can lead men to make more informed decisions about their sexual behavior.

“We are by no means advocating that providers exaggerate how prevalent HIV is within a given community,” said Sullivan. “Rather, we hope that aligning how people perceive HIV in their local environment with reality may have the potential to help improve how individuals perceive themselves at risk thereby allowing them to make informed decisions regarding prevention and testing in their everyday lives.”

The authors emphasized that it is unclear whether HIV prevalence perception leads to changes in condom use or vice versa.

“For example, rather than the scenario where someone perceiving a lower than actual HIV prevalence potentially influenced their decision not to use a condom, it may instead be the case that not using condoms and not getting a sexually transmitted infection caused someone’s perception of how prevalent HIV is in their community to diminish.”

To answer whether perception of low HIV prevalence leads to riskier behavior or the reverse requires more data taken at different points in time. Until then, it is not possible to assess which scenario may be more likely.

The HIV prevalence data used as a reference for this study came from AIDSVu, an online interactive map showing the HIV prevalence data of zip code areas across the U.S. For those who are curious about testing the accuracy of their perceptions of local HIV prevalence, this site publishes the percentage of persons in each zip code area who are HIV-positive. Users can also input characteristics like age, sex and race to find the HIV prevalence of subsets of the local population. This map, for example, shows that the HIV prevalence of South Norwalk, Connecticut, is over twelve times greater than that of its neighboring town Darien.

By showing that men’s perception of local HIV prevalence is related to their risk behavior, this study underscores the importance of developing HIV prevention programs that target not only behaviors but also beliefs.