Demographic and socio-economic determinants of poor HIV-risk perception at first HIV diagnosis: analysis of the HIV Surveillance data, Italy 2010-2016.

INTRODUCTION: HIV infections in Italy has not undergone a substantial decline over recent years. For this reason, we analysed risk-factors and socio-economic indicators of HIV-risk perception in HIV surveillance data. METHODS: An observational study was conducted and HIV-risk perception was estimated on the basis of reasons for undergoing testing. Ordinal logistic models were applied with three groups of response corresponding to three ordered levels of HIV-risk perception. RESULTS: The study included 18 055 individuals: 27% with low, 40% moderate and 33% with high perception. A low risk perception was estimated in both areas, least deprived and highly deprived [Adjusted Odds Ratio (AOR) = 1.58, CI: 1.14-2.18 and AOR = 2.33, CI: 1.39-3.90]; for heterosexuals (AOR = 1.96, CI: 1.83-2.11), Injecting Drug Users (IDU) (AOR =1.82, CI: 1.59-2.08), low education (AOR = 1.74. CI: 1.20-2.54), age > 40 years (AOR = 1.59, CI: 1.50-1.69), males (AOR = 1.30, CI: 1.20-1.40). CONCLUSIONS: In Italy there is a high percentage of HIV-infected people with poor HIV-risk perception. Poorer HIV-risk perception was associated with both, least and high deprivation, low education, older age, male gender, heterosexual and IDU groups. Our results could be relevant to address targeted HIV testing policies at both local and national levels.

Changing blood donor screening criteria from permanent deferral for men who have sex with men to individual sexual risk assessment: no evidence of a significant impact on the human immunodeficiency virus epidemic in Italy.

BACKGROUND: In 2001, the criteria for blood donor eligibility in Italy were modified by a ministerial decree from a permanent deferral for "men who have sex with men" to an individual risk assessment of sexual behaviours. The aim of this study was to evaluate the impact of this change in donor screening criteria on the human immunodeficiency virus epidemic among blood donors in Italy. MATERIALS AND METHODS: We used the data obtained from the Italian blood donor epidemiological surveillance system. We compared data collected in 2009 and 2010, when the individual risk assessment policy was applied, with data collected in 1999 when permanent deferral was applied for men who have sex with men based on a declaration of sexual orientation. We evaluated the change over time in the relative proportion of HIV antibody-positive donors who likely acquired the infection from men who have sex with men vs heterosexual sexual exposure; the relative risk was calculated using 1999 as the reference year. RESULTS: In all 3 years, the majority of HIV antibody-positive donors reported sexual exposure as a risk factor for HIV infection; this proportion increased over time, although not statistically significantly. Heterosexuals always accounted for at least 40% of all HIV antibody-positive cases. The rate of HIV antibody-positive donors increased similarly in men who have sex with men and heterosexuals; specifically, the rate of HIV antibody-positive cases per 100,000 donors was more than 2-fold higher among men who have sex with men in 2009-2010 than in 1999 (2009-2010 vs 1999, RR =2.8; P =0.06), and that among heterosexuals was 1.5 fold higher (P =0.18). DISCUSSION: When comparing the period before (1999) and after (2009-2010), the implementation of the individual risk assessment policy in 2001, no significant increase in the proportion of men who have sex with men compared to heterosexuals was observed among HIV antibody-positive blood donors, suggesting that the change in donor deferral policy did not lead to a disproportionate increase of HIV-seropositive men who have sex with men.