Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa.
Eva van Empel, Rebecca A de Vlieg, Livia Montana, F Xavier Gómez-Olivé, Kathleen Kahn, Stephen Tollman, Lisa Berkman, Till W Bärnighausen, Jennifer Manne-Goehler
Author Information
Eva van Empel: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA. evavanempel@hotmail.com. ORCID
Rebecca A de Vlieg: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
Livia Montana: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
F Xavier Gómez-Olivé: Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa.
Kathleen Kahn: Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa.
Stephen Tollman: Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa.
Lisa Berkman: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
Till W Bärnighausen: Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa.
Jennifer Manne-Goehler: Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32-37) and 34% (95% CI: 32-36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52-53) for those ≥ 15 years old and 48% (95% CI: 48-49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.
