Abstract
This study on determinants of sexual protection behavior among HIV-positive gay men used the empirically tested information-motivation-behavioral skills (IMB) model. HIV-specific variables were added to the model to determine factors decisive for condom use with steady and casual partners. Data were collected using an anonymous, standardized self-administered questionnaire. Study participants were recruited at HIV outpatient clinics associated with the Eurosupport Study Group and the Swiss HIV Cohort Study. To identify factors associated with condom use, backward elimination regression analyses were performed. Overall, 838 HIV-infected gay men from 14 European countries were included in this analysis. About 53% of them reported at least one sexual contact with a steady partner; 62.5% had sex with a casual partner during the last 6 months. Forty-three percent always used condoms with steady partners and 44% with casual partners. High self-efficacy and subjective norms in favor of condom-use were associated with increased condom use with casual and steady partners, whereas feeling depressed was associated with decreased condom use with casual partners. Condoms were used less often with HIV-positive partners. Self-efficacy as an important behavioral skill to perform protection behavior was influenced by lower perceived vulnerability, higher subjective norms, and more positive safer sex attitudes. The IMB-model constructs appeared to be valid; however, not all the model predictors could be determined as hypothesized. Besides the original IMB constructs, HIV-specific variables, including sexual partners’ serostatus and mental health, explained condom use. Such factors should be considered in clinical interventions to promote “positive prevention.”
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Antonovsky, A., & Franke, A. (1997). Salutogenese: zur Entmystifizierung der Gesundheit. Tübingen: Dgvt-Verlag.
Asboe, D., Catalan, J., Mandalia, S., Dedes, N., Florence, E., Schrooten, W., et al. (2007). Sexual dysfunction in HIV positive men is multifactorial: A study of prevalence and associated factors. AIDS Care, 19, 955–965.
Backhaus, K., Erichson, B., Plinke, W., & Weiber, R. (2003). Multivariate Analysemethoden. Eine anwendungsorientierte Einführung. Berlin: Springer-Verlag.
Bancroft, J., Janssen, E., Strong, D., & Vukadinovic, Z. (2003). The relationship between mood and sexuality in gay men. Archives of Sexual Behavior, 32, 231–242.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman.
Beyrer, C. (2008). Hidden yet happening: The epidemics of sexually transmitted infections and HIV among men who have sex with men in developing countries. Sexually Transmitted Infections, 88, 410–412.
Bouhnik, A. D., Préau, M., Schiltz, M. A., Lert, F., Obadia, Y., Spire, B., et al. (2007). Unprotected sex in regular partnerships among homosexual men living with HIV: A comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study). AIDS, 21(suppl.), S43–248.
Centers for Disease Control and Prevention. (2003). HIV treatment optimism among gay men: An international perspective. HIV/Hepatitis/STD/TB Prevention News Update. May 23, 2003. Accessed at http://www.thebody.com/content/whatis/art27995.html.
Coates, T. (2008). What is to be done? AIDS, 22, 1079–1080. Editorial comment.
Cornman, D. H., Schmiege, S. J., Bryan, A., Benziger, J., & Fisher, J. D. (2007). An information-motivation-behavioral skills (IMB) model-based HIV prevention intervention for truck drivers in India. Social Science and Medicine, 64, 1572–1584.
Costa, P. T. (2001). Gender differences in personality traits across cultures: Robust and surprising findings. Journal of Personality and Social Psychology, 81, 322–331.
Crepaz, N., Hart, T. A., & Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior. A meta-analytic review. Journal of the American Medical Association, 292, 224–236.
Crepaz, N., & Marks, G. (2001). Are negative affect states associated with HIV sexual risk behaviors. A meta-analytic review. Health Psychology, 20, 291–299.
Crepaz, N., & Marks, G. (2002). Towards an understanding of sexual risk behavior in people living with HIV: A review of social, psychological, and medical findings. AIDS, 16, 135–149.
Dallabetta, G., & Neilsen, G. (2007). Efforts to control sexually transmitted infections as a means to limit HIV transmission: What is the evidence? Current Infectious Disease Reports, 7, 79–84.
De Wit, J. B. F., Strobe, W., De Vroome, E. M. M., Sandfort, T. G. M., & van Griensven, G. J. P. (2000). Understanding AIDS preventive behavior with casual and primary partners in homosexual men: The theory of planned behavior and the information-motivation-behavioral skills model. Psychology and Health, 15, 325–340.
Elford, J., Bolding, G., Davis, M., Sherr, L., & Hart, G. (2004). Trends in sexual behavior among London homosexual men 1998–2003: Implications for HIV prevention and sexual health promotion. Sexually Transmitted Infections, 80, 451–454.
Elford, J., Bolding, G., & Sherr, L. (2001). Seeking sex on the internet and sexual risk behavior among gay men using London gyms. AIDS, 15, 1409–1415.
Elford, J., Ibrahim, F., Bukutu, C., & Anderson, J. (2007). Sexual behaviour of people living with HIV in London: Implications for HIV transmission. AIDS, 21(Suppl. 1), S13–S25.
Fishbein, M., Middlestadt, S., & Hitchcock, P. (1994). Using information to change sexually transmitted disease-related behaviors: An analysis based on theory of reasoned action. In R. DiClemente & J. Peterson (Eds.), Preventing AIDS: Theories, methods, and behavioral interventions (pp. 61–77). New York: Plenum Press.
Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111, 455–474.
Fisher, W. A., & Fisher, J. D. (1993). A general social psychological model for changing AIDS risk behavior. In J. Pryor & G. Reeder (Eds.), The social psychology of HIV infection (pp. 127–154). Hillsdale, NJ: Erlbaum.
Fisher, J. D., Fisher, W. A., Williams, S. S., & Malloy, T. E. (1994). Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university students. Health Psychology, 13, 238–250.
Glass, T. R., Young, J., Vernazza, P. L., Rickenbach, M., Weber, R., Cavassini, M., et al. (2004). Is unsafe sexual behavior increasing among HIV-infected individuals? AIDS, 18, 1707–1714.
Grossman, C., Hadley, W., Brow, L. K., Houck, C. D., Peters, A., Tolou-Shams, T., et al. (2008). Adolescent sexual risk: Factors predicting condom use across the stages of change. AIDS and Behavior, 12, 913–922.
Guttmacher Institute & the Joint Unit Nations Programme on HIV/AIDS (UNAIDS). (2006). Meeting the sexual and reproductive health needs of people living with HIV. In Brief series 2006, no. 6. Accessed at http://www.guttmacher.org/pubs/IB_HIV.pdf.
Henry, J. D., & Crawford, J. R. (2005). The short form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.
Hutton, H. E., Lyketsos, C. G., Zeilman, J. E., Thompson, R. E., & Erbelding, E. J. (2004). Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. American Journal of Psychiatry, 161, 912–914.
International HIV/AIDS Alliance. WHO (2006). “Positive prevention”: HIV prevention with people living with HIV. A guide for NGOs and service providers. Accessed at http://www.aidsalliance.org/graphics/secretariat/publications/Positive_prevention.pdf.
Jin, F., Crawford, J., Prestage, J. P., Zablotska, I., Imrie, J. C., Kippax, S. C., et al. (2009). Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS, 23, 243–252.
Kalichman, S. C. (2000). HIV transmission risk behaviors of men and women living with HIV-AIDS: Prevalence, predictors, and emerging clinical interventions. Clinical Psychology: Science and Practice, 7, 32–47.
Kalichman, S., Stein, J. A., Malow, R., Averhart, C., Dévieux, J., Jennings, T., et al. (2002). Predicting protected sexual behaviour using the Information-Motivation-Behaviour skills model among adolescent substance abusers in court-ordered treatment. Psychology, Health & Medicine, 7, 327–338.
Kapadia, F., Latka, M. H., Wu, Y., Strathdee, S. A., Mackesy-Amiti, M. E., Hudson, S. M., et al. (2009). Longitudinal determinants of consistent condom use by partner type among young injection drug users: The role of personal and partner characteristics. AIDS and Behavior. doi:10.1007/s10461-009-9569-3.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Australia: Psychology Foundation, University of New South Wales.
Maciejewski, P., Prigerson, H. G., & Mazure, C. M. (2000). Self-efficacy as a mediator between stressful life events and depressive symptoms. British Journal of Psychiatry, 176, 373–378.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Meyer, I. H., Dietrich, J., & Schwartz, S. (2008). Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. American Journal of Public Health, 98, 1004–1006.
Nöstlinger, C., Gordillo, V., Borms, R., Murphy, C., Bogner, J. R., Csépe, P., et al. (2007). Differences in perceptions on sexual and reproductive health between health care providers and people living with HIV: A qualitative elicitation study. Psychology, Health & Medicine, 13, 516–528.
O’Leary, A., Hoff, C. C., Purcell, D. W., Gomez, C. A., Parsons, J. T., Hardnett, F., et al. (2005). What happened in the SUMIT trial? Mediation and behavior change. AIDS, 19(Suppl. 1), S111–S121.
Peretti-Watel, P., Spire, B., Schiltz, M. A., Bouhnik, A. D., Heard, I., Lert, F., et al. (2006). Vulnerability, unsafe sex and adherence to HAART: Evidence from a large sample of French HIV/AIDS outpatients. Social Science and Medicine, 62, 2420–2433.
Remien, H. R., Exner, T. M., Stephen, F. M., Erhardt, A. A., Johnson, M. O., Correale, J., et al. (2007). Medication adherence and sexual risk behavior among HIV infected adults: Implications for transmission of resistant virus. AIDS and Behavior, 11, 663–675.
Richman, D. D., Morton, S. D., Wrin, T., Hellmann, N., Berry, S., Shapiro, M. F., et al. (2004). The prevalence of antiretroviral drug resistance in the United States. AIDS, 18, 1393–1401.
Sandfort, T. G., Bakker, F., Schellevis, F. G., & Vanwesenbeeck, I. (2006). Sexual orientation and mental health and physical health status: Findings from a Dutch population survey. American Journal of Public Health, 96, 1119–1125.
Schiltz, M. A., & Sandfort, T. G. M. (2000). HIV-positive people, risk and sexual behavior. Social Science and Medicine, 50, 1571–1588.
Spire, B., de Zoysa, I., & Himmich, H. (2008). HIV prevention: What have we learned from community experiences in concentrated epidemics? Journal of the International AIDS Society, 11, 5. doi:10.1186/1758-2652-11-5.
Stall, R. (2007). Efforts to prevent HIV infection that target people living with HIV/AIDS: What works? Clinical Infectious Diseases, 45(Suppl. 4), S308–S312.
Stall, R., & van Griensven, F. (2005). New directions in research regarding prevention for positive individuals: Questions raised by the Seropositive Urban Men’s Intervention Trial. AIDS, 19, S123–S127.
Stockman, J. K., Schwarcz, S. K., Butler, L. M., de Jong, B., Chen, S. Y., Delgado, V., et al. (2004). HIV prevention fatigue among high-risk populations in San Francisco. Journal of Acquired Immune Deficiency Syndrome, 35, 432–434.
Timmerman, I. G. H., Emanuels-Zuurveen, E. S., & Emmelkamp, P. M. G. (2000). The Social Support Inventory (SSI): A brief scale to assess perceived adequacy of social support. Clinical Psychology and Psychotherapy, 7, 401–410.
Van de Laar, M. J., Likatavicius, G., Stengaard, A. R., & Donoghoe, M. C. (2008). HIV/AIDS surveillance in Europe: Update 2007. Eurosurveillance, 13(50), 1–3.
Van Griensven, J. P. G., de Vroome, E. M., Goudsmit, J., de Wolf, F., van der Noorda, J., & Coutinho, R. A. (1989). Effect of human immunodeficiency virus (HIV) antibody knowledge on high-risk sexual behavior with steady and non-steady partners among homosexual men. American Journal of Epidemiology, 129, 596–603.
Vernazza, P. L., Hirschel, B., Bernasconi, E., & Flepp, M. (2008). HIV-infizierte Menschen ohne andere STDs sind unter wirksamer antiretroviraler Therapie sexuell nicht infektiös. Schweizer Ärztezeitung, 5, 265–269.
Zimmerman, R. S., Noar, S. M., Feist-Price, S., Dekthar, O., Cupp, P. K., & Anderman, E. (2007). Longitudinal test of a multiple domain model of adolescent condom use. Journal of Sex Research, 44, 380–394.
Acknowledgments
We are grateful to all study participants for contributing to this study and to the investigators at the participating centers: Austria: Birgit Mumelter (University of Innsbruck), Gabriele Schmied (European Centre, Vienna); Belgium: Ruth Borms (Sensoa, Antwerp); Czech Republic: Ivo Prochazka (University of Prague); Germany: Johannes Bogner (Ludwig Maximilians University, Munich), Werner Becker and Ramona Volkert (Private Practice, Munich), Andreas Niedermeier (University Clinic for Dermatology, Munich), Martin Karwat (Private Practice, Munich); Greece: Nikos Dedes (Synthesis, Athens); Hungary: Peter Csépe (Semmelweis University, Budapest); Italy: Gloriana Bartoli and Carlo Giaquinto (University of Padua, Padua); Caterina Uberti-Foppa and Giulia Galotta (HSR Ospedale, Milan); Latvia: Anda Vaisla (Latvian Family Planning Association, Riga); Poland: Michal Pozdal and Zbigniew Izdebski (University of Zielona Góra); Portugal: Luis Caldeira (Hospital Santa Maria, Lisbon) and Sónia Ferreira Dias (Institute of Hygiene and Tropical Medicine, Lisbon) for contributions to the manuscript; Spain: Victoria Gordillo (University Complutense of Madrid); UK: Ed Wilkins and Cinthia Murphy (Pennine Acute Hospitals NHS Trust, Manchester). Our thanks also go to the Swiss National Science Foundation and the Swiss HIV Cohort Study for funding, support and co-operation. EUROSUPPORT V received funding from the European Commission, SANCO/Public Health, grant agreement nr. 2004314. The Commission is not responsible for any use that may be made of the information contained in this publication.
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Nöstlinger, C., Nideröst, S., Platteau, T. et al. Sexual Protection Behavior in HIV-Positive Gay Men: Testing a Modified Information-Motivation-Behavioral Skills Model. Arch Sex Behav 40, 817–827 (2011). https://doi.org/10.1007/s10508-010-9682-4
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DOI: https://doi.org/10.1007/s10508-010-9682-4