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Perceived Versus Calculated HIV Risk

Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men

Blumenthal, Jill, MD*; Jain, Sonia, PhD*; Mulvihill, Evan, PharmD*; Sun, Shelly, MS*; Hanashiro, Marvin, BA*; Ellorin, Eric, MAS*; Graber, Sara, BA*; Haubrich, Richard, MD; Morris, Sheldon, MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1, 2019 - Volume 80 - Issue 2 - p e23–e29
doi: 10.1097/QAI.0000000000001888
Prevention Research

Background: Inaccurate HIV risk perception by men who have sex with men is a barrier to HIV prevention. Providing information about objective HIV risk could improve pre-exposure prophylaxis (PrEP) uptake.

Methods: PrEP Accessibility Research & Evaluation 2 (PrEPARE2) was a randomized controlled trial of men who have sex with men to determine whether an objective risk score affects future PrEP uptake. Participants completed a baseline survey to assess demographics, risk behaviors, and HIV self-perceived risk (SPR). The survey generated a calculated HIV risk (CalcR) score, estimating HIV risk based on reported condomless anal intercourse and sexually transmitted infections, and was provided to individuals in the intervention arm. Participants were contacted 8 weeks later to determine whether they initiated PrEP.

Results: Of 171 participants (median age 32 years; 37% Hispanic or non-Hispanic Black; median 5 sexual partners in the past 6 months), 81% had heard of PrEP, and 57% believed they were good PrEP candidates. SPR had poor agreement with CalcR (kappa = 0.176) with 38% underestimating their HIV risk. At week 8, only 14 of 135 participants had initiated PrEP with no difference between arms (CalcR 11%, control 10%, P > 0.99). The most common reason for not starting PrEP was low HIV risk perception. There was a relative decrease in SPR over time (P = 0.06) but no difference between arms (P = 0.29).

Conclusion: Providing an objective HIV risk score alone did not increase PrEP uptake. HIV testing performed at testing sites may be a crucial time to correct misperceptions about risk and initiate same-day PrEP, given enthusiasm for PrEP on the testing day to facilitate greater uptake.

*Department of Medicine, University of California, San Diego, La Jolla, CA; and

Gilead Sciences, Foster City, CA.

Correspondence to: Jill Blumenthal, MD, Department of Medicine, Antiviral Research Center, University of California, San Diego, 220 Dickinson Street, Suite A, San Diego, CA 92103 (e-mail:

Supported by funds from California HIV/AIDS Research Program Grant PR15-SD-021 (to S.M.), CFAR Core Grant NIH grant P30 AI036214 (to S.J.), and National Institutes of Health Grant KL2TR001444 (to J.B.).

J.B. is a Gilead US PrEP Advisor and a Gilead Educational Grant Recipient for another PrEP-related project. R.H. is now an employee of Gilead Sciences, although not when the study started or was conducted.

Received May 06, 2018

Accepted October 03, 2018

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