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.

Fig. 1

Plausible causal model of HAART-efficacy beliefs, HIV/AIDS complacency, and HIV-risk behavior

Fig. 2

Final measurement model; latent constructs in circles, measured variables in rectangles, one-headed arrows from constructs are standardized factor loadings, two-headed arrows between constructs are correlations, error (E) parameters are unexplained variance (P < 0.001 for all factor loadings and correlations)^a

Fig. 3

Original hybrid model; latent constructs in circles, measured variables in rectangles, one-headed arrows from constructs and variables are standardized path values, disturbance (D) and error (E) parameters are unexplained variance (*** P < 0.001)^a

Fig. 4

Fit indices and parameter estimates for direct paths (C, D, E, F) of alternative hybrid models, and paths A and B of the original hybrid model restricted to MSM with very low and some perceived HIV risk

Fig. 5

Final hybrid model restricted to 675 MSM with very low perceived HIV risk; latent constructs in circles, measured variables in rectangles, one-headed arrows from constructs and variables are standardized path values, disturbance (D) and error (E) parameters are unexplained variance (* P < 0.05, ** P < 0.01, *** P < 0.001)^a

Fig. 6

Final hybrid model restricted to 918 MSM with some perceived HIV risk; latent constructs in circles, measured variables in rectangles, one-headed arrows from constructs and variables are standardized path values, disturbance (D) and error (E) parameters are unexplained variance (* P < 0.05, *** P < 0.001)^a