HIV in Canada: A primer for service providers

Communication of Risk

Key Points

  • Accurate and meaningful communication of risk is important to help people understand their risk of HIV transmission and to make informed decisions.

Accurate and meaningful communication of risk is important to help people understand their risk of HIV transmission and to make informed decisions. However, it can be challenging to assess and communicate risk because each individual’s risk for HIV infection is unique, for each exposure and over time. The level of risk for sexual HIV transmission depends on:

  • The types of sex someone is having
  • The frequency of these sexual activities
  • The presence of biological factors that can increase HIV risk
  • The use of prevention strategies to decrease HIV risk

Risk assessment and communication requires an understanding of how all these factors affect a person’s overall risk for HIV transmission.

Type and frequency of sex

Talking with clients about the type and frequency of their sexual behaviour is a great place to begin a conversation about risk.

Research has estimated the average risk of HIV transmission from one exposure to HIV through different types of unprotected (when no highly effective prevention strategy is used) sexual activity. These numbers demonstrate that some sexual activities carry a much greater risk than other activities. However, these numbers represent the average risk of HIV transmission from one sexual act, so they do not account for other factors that can raise or lower risk, such as biological factors and prevention strategies. Furthermore, they reflect the average risk from one sexual act, but we know that the risk of HIV transmission increases over multiple exposures to HIV. In other words, a person’s overall risk of getting HIV increases the more they are exposed to HIV (a concept known as cumulative risk).

Accounting for factors that can impact risk

Talking with clients about the biological factors that can increase risk and about prevention strategies that can lower risk are important parts of any conversation about risk.

Research tells us that certain biological factors can increase the risk for HIV transmission. For example, a high viral load in the HIV-positive partner is the most important factor in whether or not an exposure to HIV will lead to transmission.

A person can decrease their risk for HIV transmission by using a highly effective HIV prevention strategy consistently and correctly. The effectiveness of different prevention strategies can vary greatly, but there are three highly effective strategies that reduce the risk of HIV transmission (condoms, PrEP, and antiretroviral treatment by people living with HIV to maintain an undetectable viral load).

It is impossible to come up with an exact risk estimate because the risk of HIV transmission (per exposure and over time) is unique for every individual. However, an informed discussion about all the factors at play can help a person understand how high or low their overall risk is, and how it can change.

With an understanding of how high or low their risk is, people can take measures to decrease their overall HIV risk by addressing biological factors and by using prevention strategies consistently and correctly.

Strategies for communicating risk

Clients’ understanding and perception of risk may differ depending on the way it is talked about.

Risk can generally be communicated in two ways:

  1. Using numerical (quantitative) expressions. For example, the average risk of HIV transmission during unprotected receptive anal sex is 1.4%. When discussing numbers, it is important to provide additional context, including the factors that can change risk.
  1. Using qualitative expressions. For example, the risk of HIV transmission during unprotected receptive anal sex is “very high”. When communicating risk in this way, it is important to clearly define expressions such as “high risk”, and to also discuss the factors that can change risk.

Resources

Certainly uncertain: Challenges in communicating HIV riskPrevention in Focus

Views from the front lines: Communicating riskPrevention in Focus

Sources

  1. Heise LL, Watts C, Foss A, et al. Apples and oranges? Interpreting success in HIV prevention trials. Contraception. 2011;83:10–15.
  2. Wilton J. Certainly uncertain: challenges in communicating HIV risk. Prevention in Focus. Summer 2012 issue. Available from: http://www.catie.ca/en/pif/summer-2012/certainly-uncertain-challenges-communicating-hiv-risk