Underlying factors related to HIV/AIDS prevention: investigating the willingness to take pre-exposure prophylaxis among men-who-have-sex-with-men in Germany

BACKGROUND

This study investigates the willingness of men-who-have-sex-with-men (MSM) to use HIV pre-exposure prophylaxis (PrEP). Research in the HIV/AIDS field typically relies on clinical and epidemiological studies, thereby often excluding social dimensions of the illness as well as factors explaining its prevention. The current study analyzes HIV-prevention through an interdisciplinary theoretical approach. It aims to comprehensively understand the mechanisms associated with the willingness to take PrEP among MSM in terms of psychological, social, behavioral, cultural, and demographic factors.

METHODS

We analyze data from the survey "Gay Men and AIDS" conducted in Germany in 2013 prior to market approval for PrEP. Analyses were performed using the statistical software SPSS 25.0, while results were visualized using the R programming language.

RESULTS

We find that perceived risk of infection, social norms (anticipated HIV-stigma), practices (e.g. regular condomless sex), and socio-demographic factors (young age, being single) all have a positive effect on the willingness to take PrEP, while education reveals a negative, and income no effect.

CONCLUSIONS

Results indicate that beyond well-established socio-psychological mechanisms of health behavior, social factors play a crucial role in understanding the willingness of PrEP uptake. This study enriches existing health behavior theories with sociological concepts such as social norms and social practices.

Parent-Adolescent Communication About Sex and Condom Use Among Young Men Who Have Sex With Men: An Examination of the Theory of Planned Behavior

Background

Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parent-adolescent communication about sex, particularly mother-adolescent communication, protects against adolescent sexual risk behavior. However, it is unclear whether these findings generalize to YMSM.

Purpose

The current study used the theory of planned behavior as a framework to examine how YMSM perceptions of parent-adolescent communication about condoms are associated with determinants of condom use and condomless anal sex among YMSM.

Method

YMSM ages 14-18 (M = 16.55) completed an online survey (n = 838). Associations between several domains of parent-adolescent communication about condoms (i.e., frequency and specificity, quality, and negative emotionality) and condom-related attitudes, norms, perceived behavioral control, and intentions, as well as instances of condomless anal intercourse (CAI), were examined with structural equation modeling.

Results

Multiple facets of mother-adolescent communication were associated with attitudes about condoms, subjective norms for condom use, perceived behavioral control, intentions to use condoms, and indirectly, instances of CAI. Father communication was not associated with determinants of condom use behavior.

Conclusions

Parent-adolescent communication about condoms is associated with determinants of condom use behavior among YMSM, and mother communication exerted an indirect influence on HIV-related sexual risk behaviors. Interventions designed to enhance parent- adolescent communication about condoms could prove efficacious in reducing HIV infections among YMSM.

Barriers to Safer Sex

This study of 400 heterosexual adults aged 24 to 49 years comprised married, single, separated/widowed/divorced, and cohabiting participants from three occupational groups, and concerned HIV risk within this sample. Results indicated high levels of unsafe sexual behaviours for more than onequarter of the sample, including each occupational group and relationship type. Barriers to condom use fell into five major categories: Communication Difficulties; Arousal Interference; (perceived lack of) Erotic Potential of Condoms; Trust Justification; and Practical Difficulties with Condoms. Males expressed more attitudinal barriers to condom use than females, in particular higher arousal interference and stronger use of justifications centred around trust for non-use of condoms. Higher HIV risk status was associated with maleness, younger age, single or de facto relationship status, and the attitudinal variables of high arousal interference and weaker beliefs in the erotic potential of condoms. For females only, high risk was also associated with the belief that condom use involved significant practical difficulties or ‘hassles’.

An application of the theory of planned behavior to the proximal and distal etiology of sexual offending

Emerging from social psychology, the theory of planned behavior offers a potentially useful theoretical framework for research into the etiology of sexual offending in adults and adolescents. The theory of planned behavior--a cognitive-affective theory about the role of attitudes, subjective norms, and perceived behavioral control on behaviors--may provide a means by which to link distal etiological factors into proximal ones involved in the offense process, providing greater specificity to the ''abused- abuser'' hypothesis. The theory of planned behavior also provides a theoretical framework with which to specify mechanisms involved in the proximal offense cycle. Important new directions for research resulting from this conceptual advance are presented, along with limitations of the theory in its application to the etiology of sexual offending. This theoretical framework directs practitioners to classify sexual offenders' cognitive distortions by whether they involve behavioral beliefs, normative beliefs, and/or control beliefs and to modify treatment activities accordingly.

Seroconcordant sexual partnerings of HIV-seropositive men who have sex with men

OBJECTIVES

To describe the sexual behaviors of HIV-positive men with their seroconcordant partners and to determine the factors associated with unprotected anal intercourse (UAI) in these sexual partnerings.

METHODS

The data were drawn from the baseline assessment of a randomized controlled intervention study of 1168 HIV-positive men who have sex with men recruited from mainstream gay venues, AIDS service organizations, and public/commercial sex environments.

RESULTS

Of the 1168 men, 596 engaged in sexual experiences with other HIV-positive men, and 371 of the 596 (62%) practised UAI with their seroconcordant partners. Those who engaged in UAI expressed less self-evaluation with regard to their unsafe sexual practices, had higher levels of hedonism associated with unsafe sex, and were more likely both to inject recreation drugs and use methamphetamine in particular. Furthermore, these participants expressed less concern with regard to HIV re-infection, infection with other sexually transmitted infections, and the transmission of pathogens causing opportunistic infections.

CONCLUSION

Our findings suggest that at least three sets of factors predispose HIV-positive men to engage in unsafe anal sexual behaviors with their concordant partners: a decreased belief that infection with other pathogens or re-infection with HIV present health problems; less evaluation of sexual activities and behaviors; more hedonistic expectations of sex and higher levels of sexual compulsivity, as well as recreational drug use with and without sex.

Beliefs about HIV non-infection and risky sexual behavior among MSM

As part of a larger investigation examining genetic immunity to HIV, we undertook a cross-sectional investigation of 97 HIV-seronegative men who have sex with men (MSM). Our aim was to better understand the factors to which these men attributed their HIV serostatus and to relate these attributions to sexual risk taking. Three beliefs were related to sexual risk taking with HIV-negative/status unknown casual partners: (a) medication treatment advances, (b) the low probability related to HIV transmission, and (c) a healthy immune system, capable of resisting infection. A multivariate regression model suggested that use of recreational drugs, in combination with the belief that treatment advances reduce the risk of HIV seroconversion, in part, may explain the frequency with which individuals engage in unprotected anal receptive intercourse. Our findings suggest that MSM who intentionally engage in unprotected anal sex may be influenced by perceptions that medical advances have mitigated the threat of HIV and corroborate previous studies depicting an intimate relationship between illicit drug use and sexual risk taking.

Predicting intentions versus predicting behaviors: domestic violence prevention from a theory of reasoned action perspective

A central assumption of many models of human behavior is that intention to perform a behavior is highly predictive of actual behavior. This article presents evidence that belies this notion. Based on a survey of 1,250 Philadelphia adults, a clear and consistent pattern emerged suggesting that beliefs related to domestic violence correlate with intentions to act with respect to domestic violence but rarely correlate with reported actions (e.g., talking to the abused woman). Numerous methodological and substantive explanations for this finding are offered with emphasis placed on the complexity of the context in which an action to prevent a domestic violence incident occurs. We conclude by arguing that despite the small, insignificant relationships between beliefs and behaviors found, worthwhile aggregate effects on behavior might still exist, thus reaffirming the role of communication campaign efforts.

A content analysis of hiv/aids information in psychology textbooks: implications for education, training, and practice

Early in the pandemic, psychologists who engaged in HIV/AIDS research and practice or care relied more on their "general" psychological knowledge and training than on HIV/AIDS-specific information or training for combating the disease. In the past two decades much has been gained from the contributions of psychologists working in the areas of HIV/AIDS prevention and intervention. However, little is known regarding how the discipline prepares its students for a career in HIV/AIDS research and practice/care. One important venue for educating future psychologists is college-level textbooks because they are often the students' gateway to the scientific literature in psychology. Therefore, presentation of adequate and accurate information in these texts is critical. The present study involved a review and content analysis of introductory, clinical/counseling, health, human sexuality, and social/community psychology textbooks. It revealed that some level of information regarding HIV/AIDS was found in the majority of most college-level psychology texts that were reviewed. However, many books do not present a comprehensive overview or review of this problem, and do not adequately address the role psychology and behavior change can play in abating it. Implications for education, training, and practices are discussed.

The emergency department experience of chest pain patients and their intention to delay care seeking for acute myocardial infarction

This study investigated how patients' emergency department experience was related to their intention to delay action in response to future symptoms of acute myocardial infarction. A sample of 426 persons admitted to the emergency department with a chief complaint of chest pain and released from the emergency department were contacted by telephone. Patients were queried about their affective response to the emergency department experience, their satisfaction with emergency department staff communication, their intention to delay prompt action for acute myocardial infarction symptoms in the future, the influence of others in the decision to seek care, and medical and demographic status. The results of a mixed model linear regression analysis showed that the less education patients had (p = 0.007), the less sure they felt that going to the emergency department had been "the right thing to do" (p = 0.004), and the greater the degree of embarrassment (p = 0.0001), the greater was the intention to delay action for future symptoms of acute myocardial infarction. The results also showed that those patients who were prompted by health professionals to go to the emergency department were less likely to report intentions to delay for future symptoms (p = 0.036). It is important that emergency department staff reassure chest pain patients who are sent home that they did the right thing by coming to the emergency department for their symptoms. Providers need to be particularly sensitive to feelings of embarrassment.

Attitudes and attitude change

We review empirical and conceptual developments over the past four years (1992-1995) on attitudes and persuasion. A voluminous amount of material was produced concerning attitude structure, attitude change, and the consequences of holding attitudes. In the structure area, particular attention is paid to work on attitude accessibility, ambivalence, and the affective versus cognitive bases of attitudes. In persuasion, our review examines research that has focused on high effort cognitive processes (central route), low effort processes (peripheral route), and the multiple roles by which variables can have an impact on attitudes. Special emphasis is given to work on cognitive dissonance and other biases in message processing, and on the multiple processes by which mood influences evaluations. Work on the consequences of attitudes focuses on the impact of attitudes on behavior and social judgments.

A contextual approach to research on AIDS prevention

The acquired immune deficiency syndrome (AIDS) is a disease that is transmitted almost entirely through behavioral factors. In the absence of a cure or vaccine, the modification of AIDS-risk behavior presents a unique challenge to behavioral scientists and should be taken as a clear imperative by behavior analysts. This paper discusses the currently dominant social-cognitive theories (the health belief model, the theory of reasoned action, and self-efficacy theory) that have been widely used to predict and understand AIDS-risk behavior. Although these theories have generated a voluminous literature on the cognitive, attitudinal, and demographic correlates of AIDS-risk behavior, they have not resulted in specific intervention strategies to influence risky behavior, most likely because they fail to specify manipulable variables. As an alternative to social-cognitive theories, this paper evaluates the usefulness of a behavior-analytic approach to stem the spread of HIV infection. It examines some of the philosophical differences underlying cognitive and behavioral approaches that are embedded in mechanistic versus functional contextualistic principles. It explores the theoretical and practical implications of adopting either predicting and explaining behavior or predicting and influencing behavior as the goals of science. To illustrate the value of adopting the goal of prediction and influence, behavior-analytic research on the social context of risky sexual behavior in adolescents is described. The paper argues that in order to alter the future course of the AIDS epidemic, the behavioral sciences must move beyond describing cognitive and attitudinal correlates of risky behavior and focus on the social context of the behavior of individuals. In addition, population-wide changes in AIDS-risk behavior can be accomplished only if research focuses on how to influence larger social systems, including the media, school systems, and community organizations.

Applying Social Psychological Models to Predicting HIV-Related Sexual Risk Behaviors Among African Americans

Existing models of attitude-behavior relationships, including the Health Belief Model, the Theory of Reasoned Action, and the Self-Efficacy Theory, are increasingly being used by psychologists to predict human immunodeficiency virus (HIV)-related risk behaviors. The authors briefly highlight some of the difficulties that might arise in applying these models to predicting the risk behaviors of African Americans. These social psychological models tend to emphasize the importance of individualistic, direct control of behavioral choices and deemphasize factors, such as racism and poverty, particularly relevant to that segment of the African American population most at risk for HIV infection. Applications of these models without taking into account the unique issues associated with behavioral choices within the African American community may fail to capture the relevant determinants of risk behaviors.