Gender differences in perceived and actual HIV Risk in rural high school learners in KwaZulu-Natal, South Africa

BACKGROUND: In generalized HIV epidemic settings, transitioning from adolescence to adulthood is associated with increased HIV acquisition risk. HIV risk perception influences motivation to access HIV prevention services. We examined perceived and actual HIV risk among grade 9 and 10 learners in rural KwaZulu-Natal, South Africa.
METHODS: Using baseline self-reported and serologic data collected from a clustered randomized controlled trial (2010), we used univariable and multivariable (age, grade) gender-stratified generalized estimating equations (logit link) to identify correlates of high perceived risk. We also used risk factors included in the South African Ministry of Health's (SAMOH) definition of 'substantial risk' (STI experience, condomless sex, multiple sex partners, not knowing a partner''s HIV status, and alcohol/drug use) to create a risk continuum (range: 0-5) and classification (None [0 factors] vs. Substantial [>1 factor]).
RESULTS: Among female learners, high perceived risk was associated with financial dependency (ref:financially vulnerable, aOR:1.35 [1.06-1.71]), knowledge of adolescent girls' and young women's heightened risk (aOR:1.32 [1.06-1.66]), greater condom knowledge (aOR:0.84 [0.74-0.95]), endorsement of negative HIV attitudes (aOR:1.14 [1.07-1.21]), sexual experience (aOR:1.36 [1.02-1.81]), and consistent condom use (aOR:0.44 [0.20-0.97]). For male learners, high risk perception was associated with number of social welfare grants (aOR:1.18 [1.02-1.36]), knowing an older sexual partner increases risk (aOR:1.29 [1.01-1.63]), greater condom knowledge (aOR:0.80 [0.69-0.92]), endorsement of negative HIV attitudes (aOR:1.11 [1.05-1.19]), and sexual violence survivorship (aOR:1.41 [1.04-1.90]). In the SAMOH risk continuum, females' HIV prevalence (aOR:1.22 [1.06-1.41]) and risk perception (aOR:1.10 [1.01-1.20]) increased as risk factors increased (Figure 1); however, the association between perceived and actual risk was null. Among males, all SAMOH-related associations were null.


CONCLUSIONS: In both genders, perceived risk belied actual risk, indicating a disconnect between knowledge of HIV risk factors and actual risk. Gender-differentiated approaches are needed to fill this gap and facilitate appropriate and timely access to prevention services and activities.