Evidence map›Paper›PMID 23597916›Full record

ArticleSocial science & medicine (1982)2013

Study designs for identifying risk compensation behavior among users of biomedical HIV prevention technologies: balancing methodological rigor and research ethics.

Kristen Underhill

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Social science & medicine (1982), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Cabotegravir Maintains Protective Efficacy in the Setting of Bacterial Sexually Transmitted Infections: A Secondary Analysis of HPTN 083.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
    Article
  5. Review
  6. Article
  7. PrEP Use Among Female Sex Workers: No Evidence for Risk Compensation.Journal of acquired immune deficiency syndromes (1999) · 2019
    Observational
  8. Give PrEP a chance: moving on from the "risk compensation" concept.Journal of the International AIDS Society · 2019
    Article
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  10. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

1 author.

Kristen UnderhillYale Center for Interdisciplinary Research on AIDS and Yale Law School, Yale University, New Haven, CT 06520, USA. kristen.underhill@yale.edu

Funding

PrEP for HIV Prevention in MSM: Mixed-Methods Study of Behavior & Message FramingK01MH093273 · NIMH · YALE UNIVERSITY · PI UNDERHILL, KRISTEN · 2011 to 2015
$873k
NIMH NIH HHS 1-K01-MH093273NIMH NIH HHS K01 MH093273
6 · The paper itself

Abstract

The growing evidence base for biomedical HIV prevention interventions - such as oral pre-exposure prophylaxis, microbicides, male circumcision, treatment as prevention, and eventually prevention vaccines - has given rise to concerns about the ways in which users of these biomedical products may adjust their HIV risk behaviors based on the perception that they are prevented from infection. Known as risk compensation, this behavioral adjustment draws on the theory of "risk homeostasis," which has previously been applied to phenomena as diverse as Lyme disease vaccination, insurance mandates, and automobile safety. Little rigorous evidence exists to answer risk compensation concerns in the biomedical HIV prevention literature, in part because the field has not systematically evaluated the study designs available for testing these behaviors. The goals of this Commentary are to explain the origins of risk compensation behavior in risk homeostasis theory, to reframe risk compensation as a testable response to the perception of reduced risk, and to assess the methodological rigor and ethical justification of study designs aiming to isolate risk compensation responses. Although the most rigorous methodological designs for assessing risk compensation behavior may be unavailable due to ethical flaws, several strategies can help investigators identify potential risk compensation behavior during Phase II, Phase III, and Phase IV testing of new technologies. Where concerns arise regarding risk compensation behavior, empirical evidence about the incidence, types, and extent of these behavioral changes can illuminate opportunities to better support the users of new HIV prevention strategies. This Commentary concludes by suggesting a new way to conceptualize risk compensation behavior in the HIV prevention context.

Indexed as

Research DesignRisk-TakingBiomedical TechnologyClinical Trials, Phase II as TopicClinical Trials, Phase III as TopicClinical Trials, Phase IV as TopicEthics, ResearchHIV InfectionsHumansMaleRandomized Controlled Trials as TopicRisk AssessmentBehavioral disinhibitionCondom migrationHIV preventionPlacebo-controlled trialResearch ethicsRisk compensationRisk homeostasisStudy design

Identifiers

PMID23597916
PMCPMC4047426

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.