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Measuring HIV Risk Perception and Behavior: Results from Round 1 of the Cognitive Interviewing Project with young women and men who have sex with men in South Africa


Self-reported HIV risk perception and behaviors are used in a variety of settings for diverse purposes, such as HIV prevention program planning and screening. Careful consideration of how youth in high HIV prevalence areas interpret these kinds of questions warrants attention. The Cognitive Interviewing Project (CIP) conducted cognitive interviews on common risk survey items with 30 cis-female and 20 MSM youth (18 to 24), who had recent sex with a male partner, in Cape Town and Vulindlela, South Africa. Results identified a number of potential issues including (1) confusing text; (2) mismatches of terms with local usage; (3) confusion with items requiring self-tailoring; (4) presentation concerns limiting selection of full range of answers; and (5) challenges reporting on information dependent on partner (eg., HIV risk, HIV status of partner). Self-report Items used to identify those at elevated risk for HIV should be evaluated with local populations to optimize shared understanding.

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The authors thank the participants, their partners and families, other members of the study team (Sithembile Phakathi, Makhosazana Mdladla, Nangamso Ngcwayi, Thando Wonxie, Thola Bennie), and leadership at sites (Linda-Gail Bekker, Quarraisha Abdool Karim) and FHI360/HPTN (Wafaa El-Sadr).


The Cognitive Interviewing Project (CIP) was supported by the HIV Prevention Trials Network (UM1-AI068619, UM1-AI068613, and UM1-AI068617) which received support from the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Author information

KRA chaired the CIP and led protocol development and analyses, HH and MA served as site PIs contributing to all aspects of protocol development, data collection and interpretation of findings, JM and HB conducting coding, analyses, interpretation of findings and write up. TS contributed to protocols, oversight of project implementation, and interpretation of findings. All authors contributed to manuscript finalization.

Correspondence to K Rivet Amico.

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Conflict of interest

Dr. Amico reports a grant from Gilead Sciences (ended in December 2017) outside the submitted work. Authors not named here have disclosed no conflicts of interest.

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Milne, J., Brady, H., Shato, T. et al. Measuring HIV Risk Perception and Behavior: Results from Round 1 of the Cognitive Interviewing Project with young women and men who have sex with men in South Africa. AIDS Behav (2020).

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  • Survey development
  • Cognitive interviewing
  • HIV risk perception
  • HIV risk behavior
  • Youth