Demographic and socio-economic determinants of poor HIV-risk perception at first HIV diagnosis: analysis of the HIV Surveillance
Maria Dorrucci, Vincenza Regine, Patrizio Pezzotti, Alessia Mammone, Enrico Girardi, Barbara Suligoi, and the HIV Surveillance System Group
Abstract
Introduction. HIV infections in Italy has not undergone a substantial decline over recent
years. For this reason, we analysed risk-factors and socio-economic indicators of
HIV-risk perception in HIV surveillance data.
Methods. An observational study was conducted and HIV-risk perception was estimated
on the basis of reasons for undergoing testing. Ordinal logistic models were applied with
three groups of response corresponding to three ordered levels of HIV-risk perception.
Results. The study included 18 055 individuals: 27% with low, 40% moderate and 33%
with high perception. A low risk perception was estimated in both areas, least deprived
and highly deprived [Adjusted Odds Ratio (AOR) = 1.58, CI: 1.14-2.18 and AOR =
2.33, CI: 1.39-3.90]; for heterosexuals (AOR = 1.96, CI: 1.83-2.11), Injecting Drug Users
(IDU) (AOR =1.82, CI: 1.59-2.08), low education (AOR = 1.74. CI: 1.20-2.54), age
> 40 years (AOR = 1.59, CI: 1.50-1.69), males (AOR = 1.30, CI: 1.20-1.40).
Conclusions. In Italy there is a high percentage of HIV-infected people with poor HIVrisk
perception. Poorer HIV-risk perception was associated with both, least and high
deprivation, low education, older age, male gender, heterosexual and IDU groups. Our
results could be relevant to address targeted HIV testing policies at both local and national
Keywords
Full Text:
References
Italia. Decreto Ministeriale 31 marzo 2008. Istituzione del sistema di sorveglianza delle nuove dia¬gnosi di infezione da HIV. Gazzetta Ufficiale n. 175, 28 luglio 2008;
Camoni L, Boros S, Regine V, Santaquilani M, Ferri M, Pugliese L, e Suligoi B. Aggiornamento delle nuove diagnosi di infezione da HIV dei casi di AIDS in Italia al 31 dicembre 2014. Not Ist Super Sanità 2015; 28(9) Suppl 1;
Raimondo M, Boros S, Regine V, et al. Aggiornamento delle nuove diagnosi di infezione da HIV dei casi di AIDS in Italia al 31 dicembre 2015. Not Ist Super Sanità 2016; 29(9) Suppl 1;
Mammone A, Pezzotti P, Regine V, Camoni L, Puro V, Ippolito G, Suligoi B,
Girardi E. How many people are living with undiagnosed HIV infection? An estimate
for Italy, based on surveillance data. AIDS. 2016;30(7):1131-6.
doi10.1097/QAD.0000000000001034;
Camoni L, Raimondo M, Regine V, Salfa MC, Suligoi B (2013). Late presenters
among persons with a new HIV diagnosis in Italy, 2010–2011. BMC Public
Health 13: 281;
Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study in EuroCoord, Mocroft A, Lundgren JD, Sabin ML, Monforte A, et al. . Risk factors and outcomes for late presentation for HIVpositive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med. 2013;10:e1001510. doi: 10.1371/ journal.pmed.1001510 PMID: 24137103;
The late presenters working group in COHERE in EuroCoord. Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013. Euro Surveill. 2015;20. doi: http://dx.doi.org/10.2807/1560-7917. ES.2015.20.47.30070;
Tully S, Cojocaru M, Bauch CT. Sexual behavior, risk perception, and HIV
transmission can respond to HIV antiviral drugs and vaccines through multiple
pathways. Sci Rep. 2015; 28:15411;
Corneli, A. L., McKenna, K., Headley, J., et al. EM-PrEP Study. A descriptive analysis
of perceptions of HIV risk and worry about acquiring HIV among FEM-PrEP participants
who seroconverted in Bondo, Kenya, and Pretoria, South Africa. 2014 J Int AIDS Soc,
(3 Suppl 2), 19152. doi: 10.7448/IAS.17.3.19152;
Dearborn, J. L., Lewis, J., & Mino, G. P. (2010). Preventing mother-to-child
transmissionin Guayaquil, Ecuador: HIV knowledge and risk perception. Glob Public
Health, 5(6), 649-662. doi: 10.1080/17441690903367141;
Filipe, E. M., Batistella, E., Pine, A., Santos, N. J., Paiva, V., Segurado, A., & Hearst,
N. Sexual orientation, use of drugs and risk perception among HIV-positive men in Sao
Paulo, Brazil. Int J STD AIDS 2005; 16: 56-60;
Koh, K. C., & Yong, L. S. HIV Risk Perception, Sexual Behavior, and HIV Prevalence
among Men-Who-Have-Sex-with-Men at a Community-Based Voluntary Counseling and
Testing Center in Kuala Lumpur, Malaysia. Interdiscip Perspect Infect Dis, 2014, 236240.
doi: 10.1155/2014/236240;
Evangeli M, Baker LL, Pady K, Jones B, Wroe AL. What leads some people to think they are HIV-positive before knowing their diagnosis? A systematic review of psychological and behavioural correlates of HIV-risk perception AIDS Care 2016; 28:943-53 doi: 10.1080/09540121.2016.1139040;
Clifton S, Nardone A, Field N, Mercer CH, Tanton C, Macdowall W, Johnson AM,
Sonnenberg P. HIV testing, risk perception, and behaviour in the British
population. AIDS. 2016;30:943-52. doi: 10.1097/QAD.0000000000001006;
Evangeli, M., Pady, K., & Wroe, A. L. (2015). Which Psychological Factors are Related
to HIV Testing? A Quantitative Systematic Review of Global Studies. AIDS Behav. doi:
1007/s10461-015-1246-0;
MacKellar, D. A., Valleroy, L. A., Secura, G. M., et al. Men Survey Study. (2005).
Unrecognized HIV infection, risk behaviors, and perceptions of risk among
young men who have sex with men – Opportunities for advancing HIV prevention in the
third decade of HIV/AIDS. Jaids 38, 603-614. doi0.1097/01.qai.0000141481.48348.7e;
Massari V, Lapostolle A, Grupposo MC, Dray-Spira R, Costagliola D, Chauvin P.
Which adults in the Paris metropolitan area have never been tested for HIV? A
multilevel, cross-sectional, population-based study. BMC Infect Dis. 2015;15:278. doi: 10.1186/s12879-015-1006-9;
Indicatori territoriali, ISTAT 2014; http://www.istat.it/it/archivio/16777/;
Eurostat Statistical Books 2014. Living conditions in Europe; http://ec.europa.eu/eurostat/;
Eurostat Statistical Books 2015. Quality of life, fact and views; http://ec.europa.eu/eurostat/ ;
O’Connell, A. A. (2006). Logistic regression models for ordinal response variables. Thousand Oaks, CA: Sage Publications;
Goldstein H., (2011) Multilevel Statistical Models, 4nd ed., John Wiley and Sons, Chichester, UK;
Moerbeek M. The consequences of ignoring a level of nesting in multilevel analysis. Multivariate Behavioral Research, 2004; 39:129-149. doi:10.1207/s15327906mbr3901_5;
Hachfeld A, Ledergerber B, Darling K, Weber R, Calmy A, Battegay M, Sugimoto
K, Di Benedetto C, Fux CA, Tarr PE, Kouyos R, Furrer H, Wandeler G; Swiss HIV
Cohort Study. Reasons for late presentation to HIV care in Switzerland. J Int
AIDS Soc. 2015;18: 20317. doi: 10.7448/IAS.18.1.20317;
Cuzin L, Yazdanpanah Y, Huleux T, Cotte L, Pugliese P, Allavena C, Reynes J,
Poizot-Martin I, Bani-Sadr F, Delpierre C; Dat’AIDS Study Group. No relationship
between late HIV diagnosis and social deprivation in newly diagnosed patients in
France. HIV Med. 2018;19(3):238-242. doi: 10.1111/hiv.12545;
Fantini MP(1), Lenzi J, Franchino G, et al. Mortality amenable to health care services and health inequalities among Italian Regions. Epidemiol Prev 2014;38:100-7;
Porter K, Wall PG, Evans BG. Factors associated with lack of awareness of HIV
infection before diagnosis of AIDS. BMJ. 1993;307:20-3;
Raffetti E, Postorino MC, Castelli F, et al. The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort. BMC Public
Health. 2016;16:878. doi: 10.1186/s12889-016-3477-z;
Gios L, Mirandola M, Toskin I, et al. Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols. BMC Public Health. 2016; 16:212. doi: 10.1186/s12889-016-2783-9;
Marcus U, Gassowski M, Drewes J. HIV risk perception and testing behaviours
among men having sex with men (MSM) reporting potential transmission risks in the
previous 12 months from a large online sample of MSM living in Germany. BMC
Public Health. 2016;16:1111;
Camoni L, Regine V, Stanecki K, Salfa MC, Raimondo M, Suligoi B. Estimates of the Number of People Living with HIV in Italy; Biomed Res Int.
Commento all'articolo