HIV risk perceptions and first sexual intercourse among youth in Cape Town South Africa.

CONTEXT HIV prevalence is high among South African youth. Health behavior models posit that the perceived level of risk of HIV infection is associated with the level of HIV risk behavior; however, there has been limited research in Sub-Saharan Africa on factors associated with perceived risk or on the relationship between perceived risk and risk behaviors. METHODS Longitudinal data collected in 2002 and 2005 from 3,017 black, colored and white youth in Cape Town, South Africa, were analyzed using multivariate regression to examine whether a reciprocal relationship exists between sexual experience and perceived HIV risk. Independent variables taken from the 2002 survey were used to predict dependent variables taken from the 2005 survey. RESULTS In 2005, most youth (82% of males and 83% of females) viewed themselves as being at no or small risk of HIV infection. A reciprocal relationship in which higher perceived HIV risk was associated with a delay in sexual debut (odds ratio, 0.8) and sexual experience was associated with higher perceived risk (1.4) was found for females, but not for males. Knowing someone who had died of AIDS was associated with sexual debut and with an elevated perceived HIV risk among females (1.7 and 1.3, respectively). The associations between race and perceived risk of HIV infection varied by gender. CONCLUSIONS HIV/AIDS education and prevention programs should consider more carefully how gender and race may intersect to influence risk perceptions and risk behaviors. In addition, possible reciprocal relationships between risk behaviors and risk perceptions should be considered in education and intervention programs.