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A Plausible Causal Model of HAART-Efficacy Beliefs, HIV/AIDS Complacency, and HIV-Acquisition Risk Behavior Among Young Men Who Have Sex with Men

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Abstract

Despite considerable research, the causal relationship remains unclear between HIV/AIDS complacency, measured as reduced HIV/AIDS concern because of highly active antiretroviral therapy (HAART), and HIV risk behavior. Understanding the directionality and underpinnings of this relationship is critical for programs that target HIV/AIDS complacency as a means to reduce HIV incidence among men who have sex with men (MSM). This report uses structural equation modeling to evaluate a theory-based, HIV/AIDS complacency model on 1,593 MSM who participated in a venue-based, cross-sectional survey in six U.S. cities, 1998–2000. Demonstrating adequate fit and stability across geographic samples, the model explained 15.0% of the variance in HIV-acquisition behavior among young MSM. Analyses that evaluated alternative models and models stratified by perceived risk for HIV infection suggest that HIV/AIDS complacency increases acquisition behavior by mediating the effects of two underlying HAART-efficacy beliefs. New research is needed to assess model effects on current acquisition risk behavior, and thus help inform prevention programs designed to reduce HIV/AIDS complacency and HIV incidence among young MSM.

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References

  1. Hall IH, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520–9.

    Article  PubMed  CAS  Google Scholar 

  2. Valleroy LA, MacKellar DA, Karon JM, et al. HIV prevalence and associated risks in young men who have sex with men. JAMA. 2000;284:198–204.

    Article  PubMed  CAS  Google Scholar 

  3. Centers for Disease Control and Prevention. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—five U.S. cities, June 2004–April 2005. MMWR. 2005;54:597–601.

    Google Scholar 

  4. Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR. 2008;57:985–9.

    Google Scholar 

  5. Centers for Disease Control and Prevention. Act against AIDS campaign. http://www.cdc.gov/hiv/aaa/index.htm.

  6. Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–9.

    Article  Google Scholar 

  7. Dilley JW, Woods WJ, McFarland W. Are advances in treatment changing views about high-risk sex? N Engl J Med. 1997;337:501–2.

    Article  PubMed  CAS  Google Scholar 

  8. Remien RH, Wagner G, Carballo-Dieguez A, Dolezal C. Who may be engaging in high-risk sex due to medical treatment advances? AIDS. 1998;12:1560–1.

    Article  PubMed  CAS  Google Scholar 

  9. Kelly JA, Hoffmann RG, Rompa D, et al. Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex. AIDS. 1998;12:F91–5.

    Article  PubMed  CAS  Google Scholar 

  10. Van de Ven P, Crawford J, Kippax S, et al. A scale of optimism-scepticism in the context of HIV treatments. AIDS Care. 2000;12:171–6.

    Article  PubMed  Google Scholar 

  11. International Collaboration on HIV Optimism. HIV treatment optimism among gay men: an international perspective. J Acquir Immune Defic Syndr. 2003;32:545–50.

    Article  Google Scholar 

  12. Sullivan PS, Drake AJ, Sanchez TH. Prevalence of treatment optimism-related risk behavior and associated factors among men who have sex with men in 11 states, 2000–2001. AIDS Behav. 2007;11:123–9.

    Article  PubMed  Google Scholar 

  13. Elford J, Bolding G, Maguire M, Sherr L. Combination therapies for HIV and sexual risk behavior among gay men. J Acquir Immune Defic Syndr. 2000;23:266–71.

    Article  PubMed  CAS  Google Scholar 

  14. Ostrow DE, Fox KJ, Chmiel JS, et al. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16:775–80.

    Article  PubMed  Google Scholar 

  15. Koblin BA, Perdue T, Ren L, et al. Attitudes about combination HIV therapies: the next generation of gay men at risk. J Urban Health. 2003;80:510–9.

    PubMed  Google Scholar 

  16. Van de Ven P, Kippax S, Knox S, et al. HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS. 1999;13:2289–94.

    Article  PubMed  Google Scholar 

  17. Vanable PA, Ostrow DG, McKirnan DJ, et al. Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19:134–45.

    Article  PubMed  CAS  Google Scholar 

  18. Huebner DM, Gerend MA. The relation between beliefs about drug treatments for HIV and sexual risk behavior in gay and bisexual men. Ann Behav Med. 2001;23:304–12.

    Article  PubMed  CAS  Google Scholar 

  19. Halkitis PN, Zade DD, Shrem M, Marmor M. Beliefs about HIV noninfection and risky sexual behavior among MSM. AIDS Educ Prev. 2004;16:448–58.

    Article  PubMed  Google Scholar 

  20. Kalichman SC, Nachimson D, Cherry C, Williams E. AIDS treatment advances and behavioral prevention setbacks, preliminary assessment of reduced perceived threat of HIV/AIDS. Health Psychol. 1998;17:546–50.

    Article  PubMed  CAS  Google Scholar 

  21. Kalichman SC, Eaton L, Cain E, et al. Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997–2005. Health Psychol. 2007;26:650–6.

    Article  PubMed  Google Scholar 

  22. Kalichman SC, Eaton L, White D, et al. Beliefs about treatments for HIV/AIDS and sexual risk behaviors among men who have sex with men, 1997–2006. J Behav Med. 2007;30:497–503.

    Article  PubMed  Google Scholar 

  23. Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–508.

    Google Scholar 

  24. Rogers RW. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975;91:93–114.

    Article  Google Scholar 

  25. Armitage CJ, Conner M. Social cognition models and health behaviour: a structured review. Psychol Health. 2000;15:173–89.

    Article  Google Scholar 

  26. van der Snoek EM, De Wit JBF, Mulder PGH, et al. Incidence of sexually transmitted diseases and HIV infection related to perceived HIV/AIDS threat since highly active antiretroviral therapy availability in men who have sex with men. Sex Transm Dis. 2005;32:170–5.

    Article  PubMed  Google Scholar 

  27. Stolte IG, Dukers NH, Geskus RB, et al. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS. 2004;18:303–9.

    Article  PubMed  Google Scholar 

  28. Elford J, Bolding G, Sherr L. High-risk sexual behaviour increases among London gay men between 1998 and 2001: what is the role of HIV optimism? AIDS. 2002;16:1537–44.

    Article  PubMed  Google Scholar 

  29. Elford J, Bolding G, Sherr L. Author’s response to letter I.G. Stolte et al. AIDS. 2003;17:2012–3.

    Article  Google Scholar 

  30. Williamson LM, Hart GJ. HIV optimism does not explain increases in high-risk sexual behavior among gay men in Scotland. AIDS. 2004;18:834–5.

    Article  PubMed  Google Scholar 

  31. Huebner DM, Rebchook GM, Kegeles SM. A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men. J Acquir Immune Defic Syndr. 2004;37:1514–9.

    Article  PubMed  Google Scholar 

  32. Aronson E. The theory of cognitive dissonance: a current perspective. In: Berkowitz L, editor. Advances in experimental social psychology. San Diego: Academic Press; 1969.

    Google Scholar 

  33. Peterman TA, Lin LS, Newman DR, et al. Does measured behavior reflect STD risk? An analysis of data from a randomized controlled behavioral intervention study. Sex Transm Dis. 2000;27:446–51.

    Article  PubMed  CAS  Google Scholar 

  34. Bingham TA, Harawa NT, Johnson DF, et al. The effect of partner characteristics on African American men who have sex with men in the young men’s survey, Los Angeles, 1999–2000. AIDS Educ Prev. 2002;15(Supplement A):39–52.

    Google Scholar 

  35. Harawa NT, Greenland S, Bingham TA, et al. Associations of race/ethnicity with HIV-related behaviors and prevalence among young men who have sex with men in US urban centers. J Acquir Immune Defic Syndr. 2004;35:526–36.

    Article  PubMed  Google Scholar 

  36. Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21:2083–91.

    Article  PubMed  Google Scholar 

  37. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med. 2000;342:921–9.

    Article  PubMed  CAS  Google Scholar 

  38. Montaner JSG, Hogg R, Wood E, et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006;368:531–6.

    Article  PubMed  Google Scholar 

  39. Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23:1397–404.

    Article  PubMed  Google Scholar 

  40. Sullivan P, Kayitenkore K, Chomba E, et al. Is the reduction of HIV transmission risk while prescribed antiretroviral therapy (ARVT) different for men and women? Results from discordant couples in Rwanda and Zambia (paper WEAC101). Presented at 5th international AIDS society conference on HIV pathogenesis, treatment, and prevention, July 22, 2009, Cape Town.

  41. Donnell D, Kiarie J, Thomas K, Baeten J, et al. ART and risk of heterosexual HIV-1 transmission in HIV-1 serodiscordant African couples: a multinational prospective study (paper 136). Presented at 17th conference on retroviruses and opportunistic infections, February 19, 2010, San Francisco.

  42. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs: Prentice Hall; 1980.

    Google Scholar 

  43. Armitage CJ, Conner M. Efficacy of the theory of planned behavior: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99.

    Article  PubMed  CAS  Google Scholar 

  44. MacKellar D, Valleroy L, Karon J, et al. The young men’s survey: methods for estimating HIV-1 seroprevalence and related risk factors among young men who have sex with men. Public Health Rep. 1996;111:138–44.

    PubMed  Google Scholar 

  45. Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20:731–9.

    Article  PubMed  Google Scholar 

  46. Kline RB. Principles and practice of structural equation modeling. New York: Guilford Press; 2005.

    Google Scholar 

  47. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.

    Article  PubMed  CAS  Google Scholar 

  48. Hu LT, Bentler P. Fit indices in covariance structure modeling: sensitivity to overparameterized model misspecification. Psychol Methods. 1998;3:424–53.

    Article  Google Scholar 

  49. Breckler SJ. Applications of covariance structure modeling in psychology: cause for concern? Psychol Bull. 1990;107:260–72.

    Article  PubMed  CAS  Google Scholar 

  50. MacCallum RC, Roznowski M, Necowitz LB. Model modifications in covariance structure analysis: the problem of capitalization on chance. Psychol Bull. 1992;111:490–504.

    Article  PubMed  CAS  Google Scholar 

  51. Bakeman R, Peterson JL, The Community Intervention Trial for Youth Study Team. Do beliefs about HIV treatments affect peer norms and risk sexual behavior among African-American men who have sex with men? Int J STD AIDS. 2007;18:105–8.

    Article  PubMed  Google Scholar 

  52. Szklo M, Nieto FJ. Epidemiology: beyond the basics. Sudbury: Jones and Bartlett Publishers; 2007.

    Google Scholar 

  53. Bryan A, Schmiege SJ, Broaddus MR. Mediational analysis in HIV/AIDS research: estimating multivariate path analytic models in a structural equation modeling framework. AIDS Behav. 2007;11:365–83.

    Article  PubMed  Google Scholar 

  54. Elford J. HIV treatment optimism and high-risk sexual behaviour among gay men: the attributable population risk. AIDS. 2004;18:2216–7.

    Article  PubMed  Google Scholar 

  55. Hutchinson AB, Farnham PG, Dean HD, et al. The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences. J Acquir Immune Defic Syndr. 2006;43:451–7.

    Article  PubMed  Google Scholar 

  56. Witte K, Allen M. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav. 2000;27:591–615.

    Article  PubMed  CAS  Google Scholar 

  57. Sherman DK, Nelson LD, Steele CM. Do messages about health risks threaten the self? Increasing the acceptance of threatening health messages via self-affirmation. Pers Soc Psychol Bull. 2000;26:1046–58.

    Article  Google Scholar 

  58. Richard R, van der Pligt J, de Vries N. Anticipated regret and time perspective: changing sexual risk-taking behavior. J Behav Decis Mak. 1996;9:185–99.

    Article  Google Scholar 

  59. Sandberg T, Conner M. Anticipated regret as an additional predictor in the theory of planned behaviour: a meta-analysis. Br J Soc Psychol. 2008;47:589–606.

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to the young men who volunteered for this research project and to the dedicated staff who contributed to its success. We are especially grateful to the YMS Phase II coordinators: John Hylton and Karen Yen (Baltimore); Santiago Pedraza (Dallas); Denise Fearman-Johnson and Bobby Gatson (Los Angeles); David Forest and Henry Artiguez (Miami); Vincent Guilin (New York); and Tom Perdue (Seattle).

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Correspondence to Duncan A. MacKellar.

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This study is conducted for the Young Men’s Survey Study Group.

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MacKellar, D.A., Hou, SI., Whalen, C.C. et al. A Plausible Causal Model of HAART-Efficacy Beliefs, HIV/AIDS Complacency, and HIV-Acquisition Risk Behavior Among Young Men Who Have Sex with Men. AIDS Behav 15, 788–804 (2011). https://doi.org/10.1007/s10461-010-9813-x

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