An integrated approach that simultaneously accounts for multiple dimensions of adolescents’ characteristics appears to be necessary to understanding their perceived risk of HIV.[1] According to a study of young black and Hispanic female family planning clinic clients that—unlike previous studies—included individual, interpersonal and contextual variables, 47% of youth perceived that they had no risk of HIV, 37% thought they had a low risk and 16% thought they had a medium or high risk. In bivariate analyses, variables at all three levels were associated with young women's perceived risk of HIV.

For the study, researchers surveyed sexually active black and Hispanic adolescent women visiting family planning clinics in a large southwestern U.S. city. During their clinic visit, participants completed a questionnaire that included an item assessing their perceived risk of HIV, as well as items about individual-level characteristics (e.g., demographic characteristics, risk behavior history), interpersonal-level variables (e.g., partner communication about condoms, partners’ attitudes about condoms) and contextual-level variables (e.g., peer norms about condoms). Bivariate analyses were conducted using chi-square tests and t tests to examine associations between variables and women's perceived risk of HIV; regression analyses could not be performed because many of the included variables were highly correlated.

Of the 426 young women who completed the survey, 60% were black and 40% were Hispanic; the mean age of participants was 18.5 years. Thirty-eight percent reported living with one parent, 22% with two parents, 15% with a boyfriend or spouse, 10% with extended family and the remainder with other friends or relatives. Sixty-one percent of young women were enrolled in school, 27% had graduated from high school or completed their GED and 12% had dropped out. Among the 409 adolescents who provided complete data, 47% perceived themselves to be at no risk of HIV, 37% at low risk and 16% at medium or high risk.

In bivariate analyses, demographic characteristics and other individual-level variables were found to be associated with young women's perceived risk of HIV. Nineteen percent of blacks perceived themselves as having a medium or high HIV risk, compared with 12% of Hispanics. Perception of medium or high risk of HIV was also associated with not being married and with not having children. In addition, young women's mean lifetime number of sexual partners increased with perceived risk—from 4.2 among those perceiving no risk to 6.3 among those perceiving medium or high risk. And not having used alcohol in the past 30 days and never having used marijuana were associated with the perception of no risk of HIV.

Interpersonal-level and contextual-level variables were associated with perceived risk of HIV as well. For example, 60% of young women who reported discussing condom use with their partner very often in the past year believed that they had no risk of HIV, compared with 39–43% of those who had had such discussions often, sometimes or never. Perception of having no risk of HIV was also associated with women's belief that their partner and peers hold positive attitudes toward condoms and condom use; with their certainty that they can use a condom correctly and could use one in a variety of potentially risky situations (e.g., with someone they just met); and with their confidence in their ability to avoid being pressured to have sex.

The authors note their study's limitations, which include its cross-sectional design, reliance on self-reported behavior data and limited generalizability. They comment that "the ambiguity in the literature regarding the associations between HIV risk perception and risk behaviors may suggest that studies have not utilized an integrated approach in examining factors that contribute to HIV risk perception." Integrated perspectives, they conclude, "are essential…to better understand and influence HIV risk perception among adolescents."—J. Rosenberg

Reference

1. Buzi RS et al., HIV risk perceptions among adolescents attending family planning clinics: an integrated perspective, AIDS Care, 2013, 25(1):20–27.