Perceptions of AIDS Risk and Severity And Their Association with Risk-Related Behavior Among U.S. Men.(Statistical Data Included)

According to a nationally representative sample of 3,321 men aged 20-39 surveyed in 1991, men appear well aware of the severity of AIDS: Nearly all know that AIDS destroys the immune system and that there is no cure for the disease, but a substantial minority do not think that AIDS will necessarily result in pain and death. Men's perceptions of the disease's severity seem to have little impact on their sexual behavior, with no clear relationship between men's knowledge of AIDS and their recent number of sex acts, their condom use or their participation in anal or casual sex. Men's perceptions of the general risk of human immunodeficiency virus (HIV) transmission also appear to have little impact either on their concerns about AIDS or on their behavior, but their perceptions about the AIDS rate in their local community do affect their concerns and behavior. Men know that certain kinds of behavior place them at risk, and their prior behavior significantly influences their perceptions of their own HIV risk. Howe ver, speculation about their own HIV status is only moderately related to their recent sexual behavior.

(Family Planning Perspectives, 25:74-82, 1993)

Growing concern about AIDS has increased the importance of understanding health behavior related to the transmission of the human immunodeficiency virus (HIV), which causes AIDS. As of December 1991, more than 200,000 Americans had been diagnosed with AIDS, (1) and more than one million more were estimated to be infected with HIV. (2) Estimates are that upwards of 13 million people worldwide are infected with HIV, and rates of infection appear to be increasing rapidly in many parts of the world. (3)

Medical research has discovered how HIV is transmitted and how the risk of transmission can be greatly reduced or prevented. Because HIV is transmitted only through blood and other bodily fluids, the primary modes of transmission are sexual contact, direct blood contact--i.e., intravenous drug use and needle-sharing, as well as needle pricks and surgical accidents among health care workers--and transfusion with contaminated blood. Thus, most people can easily reduce their risk of exposure to HIV by modifying their behavior--for instance, by abstaining from sex, practicing safer sex (limiting their number of partners, avoiding casual sex, using condoms and maintaining mutually faithful monogamous relationships) and not using intravenous drugs or sharing needles.

Until a medical cure or vaccine for AIDS is developed, the primary public health response to the epidemic is to educate people about reducing their risk of acquiring or transmitting HIV and to convince them to modify their behavior accordingly. It is therefore very important to learn more about health behavior related to the transmission of HIV. In particular, we need to understand why some individuals do not protect themselves adequately against HIV, and why many others who generally do not engage in high-risk behavior do so on occasion.

There is a large and growing literature on health behavior and on why individuals place themselves at risk despite their knowledge of how to avoid disease. Although there are several distinct conceptual models of health behavior in the literature, they contain many of the same components. (4) Most predict that the probability of exposure, the probability of infection if exposure occurs, and the severity of the disease itself all influence how individuals behave with respect to exposing themselves and possibly others to a specific disease. According to such models, individuals will do more to prevent exposure to a disease or avoid transmitting a disease to others when the risk of exposure is high, when the risk of contracting the disease once one is exposed is high, and when the impact of the disease is perceived as severe.

This is the first detailed description of data from the National Survey of Men (NSM-I), and hence we do not attempt to disentangle the complex interrelationships that determine behavior. Rather, we provide a general description of U.S. men's perceptions about the risk and severity of HIV infection and AIDS, and how they are associated with each other and with men's sexual behavior.