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HIV is not the only risk – using condoms or getting tested can pose risks to trust and relationships
Roger Pebody, 2018-07-06 08:00

Perceptions of risk are crucial in explaining why people do or do not make use of HIV-prevention interventions. But considerations of risk need to go beyond the risk of HIV infection to consider the personal, social, emotional, and economic risks associated with using condoms, getting tested or taking other preventative action, researchers argue.

Emily Warren and colleagues at the London School of Hygiene and Tropical Medicine conducted a systematic review of qualitative studies from African countries which examined perceptions of risk associated with HIV and people’s use of HIV prevention interventions. They found that condoms were often seen as symbolic of infidelity and mistrust, and therefore only appropriate in short-term relationships.

“Interventions themselves are replete with risks that may threaten relationship stability, economic security, and may be incompatible with the desire for a committed or loving relationship,” the researchers write.

A simple and effective method of HIV prevention – the male condom – has been available for decades, but uptake has been inconsistent. Several studies of diaphragms, microbicide gels and oral pre-exposure prophylaxis (PrEP) in African countries were hampered by low adherence. A better understanding of the factors that influence people’s use of HIV prevention interventions is therefore vital.

The systematic review included all studies which examined risk perception or uncertainty in the context of a medically regulated HIV prevention intervention (including HIV testing). To be eligible, studies had to use a qualitative method, be based on research with adults in sub-Saharan Africa and have been published in a peer-reviewed journal since 2003.

The 29 studies included were conducted in 12 countries, including several carried out in South Africa, Kenya or Malawi. Most studies examined condom use and around a third looked at various forms of HIV testing, with fewer studies researching the uptake of male circumcision, diaphragms, microbicides or PrEP. Some studies considered more than one prevention option. Seven included research with sex workers; one study was done with men who have sex with men.