| Objective In this study,we applied the theory of protective motivation to explore the factors that influence the motivation of MSM to adopt HIV prevention behaviors in response to the situation that men who have sex with men(MSM)"knowledge and behavior are separated""knowledge-activity separation"(i.e.,the knowledge of HIV is high,but the HIV infection rate also remains high).The study explores the factors that influence the motivation of MSM to adopt HIV prevention behaviors.This study will provide a scientific support for the design of future behavioral intervention strategies for MSM.Methods Repeated measurement design was used,two cross-sectional surveys were conducted in January and July 2022 using the same questionnaire for the same HIV-negative MSM population.Convenience sampling in non-probability sampling method was used to obtain the study population in the first survey,and a secondary survey was conducted 6 months later on the participants of the first survey.HIV-negative MSM from five locations in Yunnan Province,Kunming,Yuxi,Honghe,Dali and Dehong,were selected as the study population,and a sample size of 300 was determined with reference to the sample size estimation formula and questionnaire entries.This study investigated three main HIV prevention behaviors in MSM population:condom use,Pre-exposure Prophylaxis(Pr EP)and Post-exposure Prophylaxis(PEP).The study was based on the protective motivation theory,and the questionnaire included(1)sociodemographic variables:age,occupation,number of anal intercourse in the last six months,and HIV prevention behavior in recent sexual intercourse;(2)protective motivation theory factor scale:59 questions including 8dimensions of protective motivation theory,and scored by Likert five-point scale;(3)HIV prevention behavior:HIV prevention behavior in recent sexual intercourse.The use of HIV prevention measures.Descriptive statistics were used to analyze socio-demographic variables and theoretical factor scores,and~2tests were used to analyze differences in HIV prevention behaviors across demographic characteristics.Differences in theoretical factor scores were compared using analysis of variance or nonparametric tests.Data obtained from the two measurements were tested for differences,using ANOVA if the data conformed to a normal distribution and Wilcoxon signed rank test to compare whether the two samples differed if the data did not conform to a normal distribution.Reliability analysis,KMO and Bartlett’s sphericity test and confirmatory factor analysis(CFA)were used to test the reliability of the questionnaire.Structural equation modeling was used to investigate the relationship between the theoretical factors of motivation to adopt HIV prevention behaviors and motivation to protect.The structural equation model was constructed and fitted to both measurements separately,and the differences between the two fitted results were compared.Results The final 372 valid questionnaires were returned in this study,and the mean age of participants was(31.27±9.22)years,with the youngest being 17 years old and the oldest 88 years old,and 84.4%were<40 years old.Single or married living apart accounted for 67.7%.74.2%of the MSM had grown up in their current place of residence for more than 2 years.The results showed that the majority(89.5%)of HIV-negative MSM adopted preventive behaviors(including condoms,Pr EP,and PEP)during their most recent sexual intercourse.There was a statistically significant difference in the adoption of HIV prevention behaviors among MSM with different number of anal intercourse in the last six months(χ^2=11.592,P<0.05).The results of the questionnaire reliability test showed that the questionnaire had good reliability and could well measure the theoretical factors of motivation to adopt HIV prevention behavior among MSM.The results of questionnaire score analysis showed that MSM had higher levels of the three theoretical factors of self-efficacy,response efficacy,and protective motivation when using condoms than when using both Pr EP and PEP,and lower response cost,with statistically significant differences(P<0.001).the differences in questionnaire scores for PEP self-efficacy,PEP,and Pr EP response cost between the two measures were statistically significant.Results of structural equation modeling analysis showed that protective motivation theoretical factors had an influential and predictive effect on MSM motivation to adopt HIV prevention behaviors.Self-efficacy influenced MSM motivation to adopt condoms(path coefficient 0.801,P<0.05),Pr EP(0.777,P<0.05),and PEP(0.672,P<0.05),showing that the higher the self-efficacy,the more likely it was to develop protective motivation to adopt prevention behaviors;susceptibility had a positive effect on MSM motivation to use Pr EP(0.147,P<0.05);response efficacy(0.148,P<0.05)and response cost(0.257,P<0.05)had an effect on MSM’s motivation to adopt PEP,with greater response efficacy and smaller response cost favoring MSM’s motivation to use PEP.The results of structural equation modeling for both measures showed that self-efficacy was the most stable influence on the adoption of HIV prevention behaviors among MSM.Conclusions The results of this study provide scientific support for the development of HIV prevention behavioral intervention strategies among MSM.1.The questionnaire designed in this study can effectively measure the levels of HIV prevention protective motivation among MSM and can be used in future explorations of HIV prevention behavioral motivation among MSM.2.MSM are more motivated to use condoms than to use Pr EP and PEP,and the latter are more likely to change than the former.HIV prevention interventions targeting Pr EP and PEP can yield relatively faster results.3.Self-efficacy is a key factor in motivating MSM to use protection.The design and development of interventions can focus on self-efficacy to enhance the motivation of MSM to adopt HIV prevention behaviors. |
PDF Full Text Request