Although virtually all major theories of health-protective behavior assume that precautionary behavior is related to perceived vulnerability, the applicability of this assumption to human immunodeficiency virus (HIV) preventive behavior has recently been called into question. This article uses qualitative and quantitative methods to review and integrate the literature relevant to the relation between perceived vulnerability to HIV and precautionary sexual behavior. Specifically, the purpose of the article is to determine whether the extent research supports 2 hypotheses regarding this relation; (a) Perceptions of personal vulnerability to HIV are reflections of current and recent risk and precautionary behavior, and (b) these perceptions motivate precautionary sexual behavior. In addition, it examines the conceptual and methodological strengths and weaknesses of the empirical literature on these questions and provides recommendations for future research.
PIP: A review of the research literature on the relationship between sexual behavior and perceptions of vulnerability to human immunodeficiency virus (HIV) provided limited support for the hypothesis that risk and preventive measures influence estimates of vulnerability, but no support for the theory that perceptions of vulnerability to HIV motivate subsequent precautionary sexual behavior. The 32 primarily cross-sectional studies published on this topic from 1986-94 encompassed 15,440 participants. Condom use was significantly less likely to be related to risk estimates than measures that combined two or more risk and preventive behaviors. Groups at low risk of HIV (e.g., older people, women, and college students) were more likely than their high-risk counterparts to base their risk estimates on their behavior. Age, gender, experience with risk behaviors, and risk status all seemed to affect whether risk perceptions were a reflection of current behavior and the motivational power of these perceptions. Four factors specific to the HIV epidemic are assumed to explain the lesser applicability of health protective behavior models to this condition compared to non-fatal threats: emotions associated with decisions about sex, the social nature of precautionary sexual behavior, the lengthy incubation period for HIV, and the uncertainty and ambiguity surrounding the process of infection. Recommended, to expand theoretical and practical knowledge of this issue, are longitudinal studies, measures of the affective as well as cognitive dimensions of vulnerability perceptions, and experimental studies.