title: Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: an information--motivation--behavioral skills model analysis.
abstract: OBJECTIVE
  The current study applied the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992; Fisher & Fisher, 1993) to identify factors associated with human immunodeficiency virus (HIV) transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa's generalized HIV epidemic.
  
  
  METHODS
  HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa.
  
  
  RESULTS
  Findings confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, whereas for women, the effect of HIV prevention motivation works through HIV prevention behavioral skills to affect HIV preventive behavior.
  
  
  CONCLUSIONS
  These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa's generalized HIV epidemic.
authors.affiliation: Department of Community Medicine and Health Care,University of Connecticut School of Medicine, Farmington,CT 06030, USA. kiene@uchc.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kiene
authors.forename: William A
authors.initials: WA
authors.lastname: Fisher
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Cornman
authors.forename: Sarah
authors.initials: S
authors.lastname: Christie
authors.forename: Susan
authors.initials: S
authors.lastname: Macdonald
authors.forename: Sandy
authors.initials: S
authors.lastname: Pillay
authors.forename: Gethwana
authors.initials: G
authors.lastname: Mahlase
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D013019:South Africa; D055815:Young Adult