ACTUAL RISK AND PERCEIVED RISK: WHAT MATTERS FOR PREP USE IN BLACK AND LATINX SEXUAL AND GENDER MINORITY YOUTH (BLSGMY)?

• Published in: Journal of adolescent health 2021-02, Vol.68 (2S), p.S31
• Main Authors: Grimaldi, Gabriella, Vickroy, William, Festinger, David, Lopez, Alexander, Hailey-Fair, Kimberly, Castillo, Marne, Galai, Noya, Cos, Travis, Arrington-Sanders, Renata
• Format: Article
• Language: English
• Subjects: Age; Anal intercourse; Antiretroviral drugs; Gender identity; HIV; Human immunodeficiency virus; Motivation; Perceptions; Risk assessment; Risk behavior; Risk factors; Risk perception; Sexual behavior; Sexual orientation; Sexually transmitted diseases; STD; Substance abuse; Tests; Uptake; Willingness
• ISSN: 1054-139X; 1879-1972

Purpose: There has been limited uptake of pre-exposure prophylaxis (PrEP) among BLSGMY who are at risk for HIV. Perception of HIV risk has been thought be related to uptake. Some have suggested that BLSGMY may not accurately perceive risk and, perception of risk may not reflect actual reported risk. It is unclear whether actual or perceived risk is predictive of PrEP use. We sought to explore actual and perceived HIV risk and which was associated with ever having used PrEP in a sample of BLSGMY from Baltimore, MD; Washington, D.C. and Philadelphia, PA. Methods: A total of 306 BLSGMY, HIV negative, assigned male sex at birth, were recruited to participate in a cross-sectional survey about sexual risk, PrEP use and substance use behavior. We created a 6-item summative HIV Risk (continuous, range = 0-6) scale, with the risk factors: engaging in condomless anal intercourse, substance use, STI history, partner diagnosed with HIV and exchanging sex for basic needs. An 8-item Perceived Risk of HIV infection scale (PRHS-8; Napper et al„ 2012) was used to measure perceived risk of HIV among participants. The primary outcome was ever having taken PrEP. We used chi-squared and logistic regression analyses to examine the relationship between actual and perceived HIV risk and ever having taken PrEP. We also explored factors associated with perception and actual risk and whether there was an interaction between actual and perceived HIV risk for reporting ever having taken PrEP. This study was IRB approved. Results: The mean age was 20.6 years (SD = 2.45). Age (x2 (2, N = 306) = 7.88, p < .01) and higher score on the HIV Risk scale (x2 (2, N = 304) = 24.9, p < .001) were positively associated with ever PrEP use, whereas perceived risk, gender identity, sexual orientation was not. Yet, perceived risk was correlated with actual risk (0.22, p < 0.001). Perceived risk for HIV was associated with increased engagement in HIV testing (OR 1.48, 95% CI 1.03-2.13) and willingness to take PrEP (OR 2.45.95% CI 1.52-3.95). In the final model, controlling for age and perceived risk, for each increase in actual risk, there was a 1.62 greater odds (95% CI: 1.29-2.02) of ever using PrEP. The model explained 13% (Nagelkerke = 0.133) of the variance in PrEP use. The interaction between perceived and actual risk was not significant. Conclusions: Findings suggest that higher HIV risk may positively move BLSGMY toward PrEP use. More work is needed to understand if there is a tipping point for