Tijuana, Baja California, Mexico. Logistic regression was used to determine factors associated with high-perceived risk of HIV infection. Participants who reported high-perceived risk of HIV infection participated in high-risk behaviors such as injecting with used syringes, transactional sex, and were less likely to have had an HIV test.
Recognition of HIV infection risk was associated with high risk behaviors and markers of vulnerability. Findings support efforts to encourage HIV testing and access to health care for this vulnerable population. HIV; risk perception and injection drug use; epidemiology; Mexico. A number of factors, including poverty and the struggling economy, contribute to the growing problem of drug use in Tijuana. Studies among drug users indicate that low perceived risk of HIV infection is associated with riskier behaviors, 9 but that high risk perception does not always translate to protective behaviors.
of risky behaviors may not be enough to prevent engagement in such behaviors; therefore, it is important to understand factors associated with perceived HIV risk. Much of the research on risk perception focuses on increasing awareness of risk behaviors and increasing risk perception or the sense of vulnerability of HIV with the hope of decreasing high risk behaviors.
As noted by Klein and colleagues, missing from the literature is information about factors associated with risk perception and differences between individuals who engage in high risk behaviors but perceive low risk, and those who engage in high risk behaviors and perceive high risk.
Data for this study were taken from the baseline computer assisted personal interview and included demographic information, drug use and sexual behaviors, and perceived risk of HIV infection. Reactive samples were confirmed at the San Diego County Department of Health using enzyme immunoassay and immunofluorescence assay. Those with positive tests were referred to the municipal health clinic in Tijuana for follow-up care.
An incentive of 10 USD was given to participants for their time and transportation to complete this study. The dependent variable in this analysis was self perceived risk of HIV infection and was assessed using the following question: Participants could also refuse to answer. Responses were dichotomized into two risk perception categories: While this is not a pre-validated scale of risk perception, this outcome has been used in other studies as a reliable measure of HIV risk perception.
Thus, PWID were included in this analysis. Descriptive statistics, such as frequencies and means, were calculated for variables potentially associated with HIV risk perception. Logistic regression with robust variance estimation via generalized estimating equation was used to examine bivariate relationships between perceived risk of HIV infection and factors potentially associated with it.
Interactions were tested and potential confounders were assessed. Collinearity was assessed and ruled out in the final model using variance inflation factors and condition indices. Of the participants, The prevalence of HIV was 4. In terms of risk perception, In bivariate analysis, compared to PWID who perceived themselves at the same or lower risk of HIV than other PWID, those who perceived themselves as more likely to get infected were more likely to be male Participants with high-risk perception were also more likely to report never having had a prior HIV test Though sexual activity was not prevalent in this cohort, participants who reported high-perceived risk of HIV infection were less likely to report having sex in the past 6 months Additional comparisons and results from bivariate analyses can be found in table I.
One explanation is that Riesgo contraer vih relacion heterosexual relations who receive a negative HIV test result might feel like they are at lower risk because, while they are engaging in risky behaviors, they have yet to get infected with HIV.
These vulnerabilities may influence risk perception and lead to high-risk behaviors such as transactional sex for something they needed or sharing injection equipment. Deportees who Riesgo contraer vih relacion heterosexual relations higher perceived risk of HIV had been injecting drugs for a shorter amount of time, lived in the US for a shorter duration, and were less likely to participate in high-risk sexual encounters. Research has also shown that a lack of stable housing influences HIV risk, and that housing assistance may reduce risk behaviors.
Though we did not assess HIV knowledge in our population, health insurance may indicate increased awareness of HIV risk behaviors and better access to health care, thus, PWID with health insurance had higher risk perception.
One study among MSM that men with health insurance were less
Riesgo contraer vih relacion heterosexual relations to engage in unprotected anal intercourse. For some PWID, drug use may be more important than sex, leading to limited sexual activity.
In our sample, the majority of participants were heroin users and heroin is associated with decreased libido. However, we do not know if high-risk perception precluded sexual activity. The results of our study must be interpreted with some limitations in mind. The cross-sectional design of this analysis limits our ability to determine causal inferences and determine temporality.
Therefore, we cannot assess whether self-perceptions of HIV risk among PWID is a precursor or a consequence of their risk behaviors and personal circumstances. Risk perception may also change rapidly based on individual, social, and environmental factors. Heightened perception of risk could lead to a change in injection and sexual practices, or recent injection and sexual practices may heighten perceptions of risk among PWID.
Given the sensitive nature of drug use Riesgo contraer vih relacion heterosexual relations high-risk behaviors that could lead to disease transmission, this study may suffer from under-reporting of related behaviors.
However, this study relied on highly trained interviewers established a strong rapport with participants to increase the reliability of the data collected. This study identified several correlates of self-perceived HIV risk that may help researchers better understand how PWID think about their risk behaviors to help shape intervention strategies.
It is possible that PWID perceive increased risk of infection due to their participation in high-risk behaviors such as higher frequency of injection,
Riesgo contraer vih relacion heterosexual relations in sex exchange, and high-risk injection behaviors.
Though we did not assess knowledge of HIV, other studies show that knowledge is not associated with reduced risk behaviors. Our results indicate that intervention programs should address structural barriers to safe injection such as homelessness, deportation, health care access while providing education messages to prevent high-risk behaviors. Education and intervention programs should also emphasize continuity of HIV prevention messages, especially among and PWID who report the riskiest behaviors.
One such intervention is to increase HIV testing among PWID, which could also serve to provide needed prevention messages to high-risk individuals.
Lastly, studies that assess how risk perception changes in varying situations and over time are needed to better understand the relationship between engaging in high-risk behaviors and risk perception. The authors thank the study participants for volunteering their time and staff for their work on this study. The authors also thank Alexis Roth for her review of the final version of the paper. Secretaria de Salud; Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico.
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