CHANGE OVER TIME IN THE HUMAN IMMUNODEFICIENCY VIRUS RISK PERCEPTIONS OF YOUTH

ABSTRACTAlthough the vulnerability of young people to HIV/AIDS continues to be a serious concern in South Africa, no research has used a representative sample of South African youth to examine whether individual HIV risk perceptions change over time and, if they do, what factors are associated with change. Using data from the Cape Area Panel Study, a multi-racial, longitudinal study of youth and their households, this study examined whether youth change their HIV risk perceptions over a four-year period and whether sexual behaviors, knowing someone with HIV, gender and race are associated with any change. Overall, changes in HIV risk perceptions tend to be small. As predicted, sexual activity is associated with increases in risk perceptions. Contrary to predictions, condom use at last sex is associated with increases in risk perceptions and knowing someone with HIV is associated with decreases in risk perceptions. In addition, there is variation by gender and by race in the factors associated with change in risk perceptions. This study serves as an initial examination of change in the HIV risk perceptions of South African youth; further investigation of their HIV risk perceptions over time is needed.Keywords: HIV/AIDS, Risk Perceptions, First Sex1. INTRODUCTIONIn recent years, hopeful signs regarding the HIV/AIDS epidemic among young people in South Africa have emerged. HIV prevalence among young people in South Africa appears to be stabilizing. For 15- 24 year-olds, national HIV prevalence rates were estimated at 9.3% in 2002, 10.3% in 2005 and 8.7% in 2008, the most recent year for which national HIV prevalence data are available (Shisana and Simbayi, 2002; Shisana, 2009). HIV incidence appears to have declined in recent years among teenage males and females and 20-24 year-old females (Fraser-Hurt et al., 2011), which has been attributed to increases in condom use among young people (Shisana, 2009).In spite of these encouraging trends, the vulnerability of young people to HIV/AIDS continues to be a serious concern in South Africa. HIV transmission largely occurs through heterosexual intercourse in South Africa and portions of the youth population continue to engage in sexual behaviors that place them at risk of HIV infection (Shisana, 2009; Fraser-Hurt et al., 2011). Risk perceptions are a central component of many models of health behavior (for a recent review, Aiken et al., 2012). These models give rise to the behavior motivation hypothesis, or the prediction that individuals who perceive themselves to be at risk of a disease will engage in behaviors known to prevent the disease (Brewer et al., 2004). Numerous studies of disease have tested the behavior motivation hypothesis; fewer studies have tested the risk reappraisal hypothesis, or the prediction that taking an action believed to reduce risk of a disease will lower self-perceived risk for the disease (Brewer et al., 2004). Research to date (to the best of our knowledge) has not specifically considered whether the HIV risk perceptions of South African youth change over time and if they do, what factors are associated with change. This study uses data from the Cape Area Panel Study (CAPS), a longitudinal study of youth and their households from Cape Town, South Africa, to examine whether HIV risk perceptions change over a four-year period and whether sexual behaviors, knowing someone with HIV, race and gender are associated with any change.1.1. HIV Risk PerceptionsA number of studies have found that young South Africans often perceive their risk of HIV infection to be low, even if they engage in sexual risk behaviors (Macintyre et al., 2004; Anderson et al., 2007; Kenyon et al., 2010a; Fraser-Hurt et al., 2011), which may reflect youthful optimism and feelings of invulnerability (Moore and Rosenthal, 1991; Macintyre et al., 2004). (For studies finding that young South Africans have at least moderate levels of knowledge about the sexual transmission of HIV, (Anderson and Beutel, 2007; Shisana, 2009; Fraser- Hurt et al. …