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.
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.
authors.affiliation: Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dym4@cdc.gov
authors.forename: Duncan A
authors.initials: DA
authors.lastname: Mackellar
authors.forename: Su-I
authors.initials: SI
authors.lastname: Hou
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
authors.forename: Karen
authors.initials: K
authors.lastname: Samuelsen
authors.forename: Linda A
authors.initials: LA
authors.lastname: Valleroy
authors.forename: Gina M
authors.initials: GM
authors.lastname: Secura
authors.forename: Stephanie
authors.initials: S
authors.lastname: Behel
authors.forename: Trista
authors.initials: T
authors.lastname: Bingham
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Koblin
authors.forename: Marlene
authors.initials: M
authors.lastname: LaLota
authors.forename: Douglas
authors.initials: D
authors.lastname: Shehan
authors.forename: Hanne
authors.initials: H
authors.lastname: Thiede
authors.forename: Lucia V
authors.initials: LV
authors.lastname: Torian
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D012306:Risk; D012309:Risk-Taking; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult