title: Actual sexual risk and perceived risk of HIV acquisition among HIV-negative men who have sex with men in Toronto, Canada.
abstract: BACKGROUND
  Theory suggests that perceived human immunodeficiency virus (HIV) risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk.
  
  
  METHODS
  Sexually active men who have sex with men (MSM) were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI). Actual HIV risk (primary predictor) was constructed by applying principal component analysis (PCA) to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome) was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk.
  
  
  RESULTS
  One hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37-50 years]). Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR) 18.33, 95% confidence interval (CI) 1.65-203.45). Older age was associated with lower perceived risk but only age 40-49 compared to less than 30 was statistically significant (OR 0.12, 95% CI 0.016-0.86). The odds of having high perceived risk was significantly associated with men who used poppers in the previous 6 months compared to those who did not use poppers (OR 5.64, 95% CI 1.20-26.48).
  
  
  CONCLUSIONS
  Perceived HIV risk increased significantly as condom use with an HIV-positive regular partner decreased. However, perceived HIV risk was not associated with condom use with casual partners or HIV unknown status regular partners, even though these behaviours could be considered risky. The relationship between perceived and actual risk in HIV studies is complex and has implications on how health care workers address the issue of risky sexual behaviour and perceived risk.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Maya.kesler@mail.utoronto.ca.
authors.forename: Maya A
authors.initials: MA
authors.lastname: Kesler
authors.affiliation: Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Juan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.|Maple Leaf Medical Clinic, Toronto, ON, Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Dionne
authors.initials: D
authors.lastname: Gesink
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Ted
authors.initials: T
authors.lastname: Myers
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Remis
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology*; D006679:HIV Seropositivity; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010465:Perception; D018570:Risk Assessment; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Actual risk; Canada; Human immunodeficiency virus; Men who have sex with men; Perceived risk; Principal components analysis; Toronto