Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 4/2011

01-05-2011 | Original Paper

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

Authors: Duncan A. MacKellar, Su-I Hou, Christopher C. Whalen, Karen Samuelsen, Linda A. Valleroy, Gina M. Secura, Stephanie Behel, Trista Bingham, David D. Celentano, Beryl A. Koblin, Marlene LaLota, Douglas Shehan, Hanne Thiede, Lucia V. Torian

Published in: AIDS and Behavior | Issue 4/2011

Login to get access

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.
Literature
1.
Hall IH, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520–9.PubMedCrossRef
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.PubMedCrossRef
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.
4.
Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR. 2008;57:985–9.
5.
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.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
11.
International Collaboration on HIV Optimism. HIV treatment optimism among gay men: an international perspective. J Acquir Immune Defic Syndr. 2003;32:545–50.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
23.
Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–508.
24.
Rogers RW. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975;91:93–114.CrossRef
25.
Armitage CJ, Conner M. Social cognition models and health behaviour: a structured review. Psychol Health. 2000;15:173–89.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
29.
Elford J, Bolding G, Sherr L. Author’s response to letter I.G. Stolte et al. AIDS. 2003;17:2012–3.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.
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.PubMedCrossRef
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.
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.
43.
Armitage CJ, Conner M. Efficacy of the theory of planned behavior: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99.PubMedCrossRef
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
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.PubMedCrossRef
46.
Kline RB. Principles and practice of structural equation modeling. New York: Guilford Press; 2005.
47.
48.
Hu LT, Bentler P. Fit indices in covariance structure modeling: sensitivity to overparameterized model misspecification. Psychol Methods. 1998;3:424–53.CrossRef
49.
Breckler SJ. Applications of covariance structure modeling in psychology: cause for concern? Psychol Bull. 1990;107:260–72.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
52.
Szklo M, Nieto FJ. Epidemiology: beyond the basics. Sudbury: Jones and Bartlett Publishers; 2007.
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.PubMedCrossRef
54.
Elford J. HIV treatment optimism and high-risk sexual behaviour among gay men: the attributable population risk. AIDS. 2004;18:2216–7.PubMedCrossRef
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.PubMedCrossRef
56.
Witte K, Allen M. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav. 2000;27:591–615.PubMedCrossRef
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.CrossRef
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.CrossRef
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.PubMedCrossRef
Metadata
Title
A Plausible Causal Model of HAART-Efficacy Beliefs, HIV/AIDS Complacency, and HIV-Acquisition Risk Behavior Among Young Men Who Have Sex with Men
Authors
Duncan A. MacKellar
Su-I Hou
Christopher C. Whalen
Karen Samuelsen
Linda A. Valleroy
Gina M. Secura
Stephanie Behel
Trista Bingham
David D. Celentano
Beryl A. Koblin
Marlene LaLota
Douglas Shehan
Hanne Thiede
Lucia V. Torian
Publication date
01-05-2011
Publisher
Springer US
Published in
AIDS and Behavior / Issue 4/2011
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-010-9813-x

Other articles of this Issue 4/2011

AIDS and Behavior 4/2011 Go to the issue

Original Paper

Factors Associated with HIV Testing History and Returning for HIV Test Results Among Men Who have Sex with Men in Thailand

Original Paper

The Impact of Highly Active Antiretroviral Therapy on Activities of Daily Living in HIV-Infected Adults in South Africa

Original Paper

Client Characteristics and HIV Risk Associated with Repeat HIV Testing Among Women in Ethiopia

Original Paper

Latent Class Analysis of Sexual Risk Patterns Among Esquineros (Street Corner Men) a Group of Heterosexually Identified, Socially Marginalized Men in Urban Coastal Peru

Original Paper

A Behavioral Decision Model Testing the Association of Marijuana Use and Sexual Risk in Young Adult Women

OriginalPaper

Patient–Provider Communication Differs for Black Compared to White HIV-Infected Patients
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits