Sibylle Nideröst

Condom use with steady partners among heterosexual people living with HIV in Europe: testing the information-motivation-behavioral skills model.

Guided by a modified information-motivation-behavioral skills model, this study identified predictors of condom use among heterosexual people living with HIV with their steady partners. Consecutive patients at 14 European HIV outpatient clinics received an anonymous, standardized, self-administered questionnaire between March and December 2007. Data were analyzed using descriptive statistics and two-step backward elimination regression analyses stratified by gender. The survey included 651 participants (n = 364, 56% women; n = 287, 44%). Mean age was 39 years for women and 43 years for men. Most had acquired HIV sexually and more than half were in a serodiscordant relationship. Sixty-three percent (n = 229) of women and 59% of men (n = 169) reported at least one sexual encounter with a steady partner 6 months prior to the survey. Fifty-one percent (n = 116) of women and 59% of men (n = 99) used condoms consistently with that partner. In both genders, condom use was positively associated with subjective norm conducive to condom use, and self-efficacy to use condoms. Having a partner whose HIV status was positive or unknown reduced condom use. In men, higher education and knowledge about condom use additionally increased condom use, while the use of erectile-enhancing medication decreased it. For women, HIV disclosure to partners additionally reduced the likelihood of condom use. Positive attitudes to condom use and subjective norm increased self-efficacy in both genders, however, a number of gender-related differences appeared to influence self-efficacy. Service providers should pay attention to the identified predictors of condom use and adopt comprehensive and gender-related approaches for preventive interventions with people living with HIV.

Explaining the condom use of heterosexual men in a high-income country: adding somatic culture to the theory of planned behaviour

Against the background of an upward trend in newly diagnosed HIV infections and the increasing importance of heterosexual HIV transmission in Europe and Switzerland, the theory of planned behaviour has been tested and extended in a prospective study on condom use in a community sample of heterosexual men. Nine hundred eighty-two Swiss men between the ages of 25 and 65 were surveyed using standardised questionnaires in two computer-assisted telephone interviews. The theory of planned behaviour proved to be able to predict condom use in sexual encounters with new and casual partners. Condom use was predicted by intention. Perceived behavioural control and attitude were significant predictors of intention, whereas the subjective norm was not. Thus, in line with other studies, the present study highlighted the somewhat limited explanatory power of the theory. By adding the socio-cultural variable “somatic culture” to the model, the proportion of explained variance of intention was increased from 36 to 45 per cent. In light of these findings, prevention efforts should be more differentiated and specific in order to meet the specificities of the different types of somatic culture of the men they are targeting.

Predictors of HIV-protection behaviour in HIV-positive men who have sex with casual male partners: a test of the explanatory power of an extended Information–Motivation–Behavioural Skills model

Abstract This prospective study applies an extended Information–Motivation–Behavioural Skills (IMB) model to establish predictors of HIV-protection behaviour among HIV-positive men who have sex with men (MSM) during sex with casual partners. Data have been collected from anonymous, self-administered questionnaires and analysed by using descriptive and backward elimination regression analyses. In a sample of 165 HIV-positive MSM, 82 participants between the ages of 23 and 78 (M=46.4, SD=9.0) had sex with casual partners during the three-month period under investigation. About 62% (n=51) have always used a condom when having sex with casual partners. From the original IMB model, only subjective norm predicted condom use. More important predictors that increased condom use were low consumption of psychotropics, high satisfaction with sexuality, numerous changes in sexual behaviour after diagnosis, low social support from friends, alcohol use before sex and habitualised condom use with casual partner(s). The explanatory power of the calculated regression model was 49% (p<0.001). The study reveals the importance of personal and social resources and of routines for condom use, and provides information for the research-based conceptualisation of prevention offers addressing especially people living with HIV (“positive prevention”).

Acceptability and willingness to use HIV pre-exposure prophylaxis among HIV-negative men who have sex with men in Switzerland

ABSTRACT Pre-exposure prophylaxis (PrEP) is discussed as an additional HIV prevention method targeting men who have sex with men (MSM). So far, PrEP has not been approved in Switzerland and only little is known about the acceptability of PrEP among MSM living in Switzerland. Given the slow uptake of PrEP among MSM in the USA, the objectives of the study were to investigate the acceptability for PrEP and to identify factors influencing the acceptability for this prevention method and the willingness to adopt it. During a 4-month period we conducted five focus group discussions with 23 consecutively sampled HIV-negative MSM aged 22–60 years living in Switzerland. We analyzed the data according to qualitative content analysis. The acceptability of PrEP varied considerably among the participants. Some would use PrEP immediately after its introduction in Switzerland because it provides an alternative to condoms which they are unable or unwilling to use. Others were more ambivalent towards PrEP but still considered it (1) an additional or alternative protection to regular condom use, (2) an option to engage in sexual activities with less worries and anxieties or (3) a protection during receptive anal intercourse independently of the sexual partners protective behaviour. Some participants would not consider using PrEP at all: they do not see any benefit in PrEP as they have adopted safer sex practices and did not mention any problems with condom use. Others are still undecided and could imagine using an improved form of PrEP. The results provide a valuable basis for a model explaining the acceptability of PrEP among MSM and suggest including the personal HIV protection strategy in the considerations adopted.

Aging With HIV in the Era of Antiretroviral Treatment Living Conditions and the Quality of Life of People Aged Above 50 Living With HIV/AIDS in Switzerland

The aim of this cross-sectional study was to identify the living conditions and the quality of life of people aged more than 50 who were living with HIV in Switzerland. Participants were consecutively sampled through different HIV-specific sites. Seventy-two HIV-positive persons filled in an anonymous standardized questionnaire, either paper-pencil or online. Descriptive and inferential statistics were calculated. Quality of life was rated quite high (M = 14.9, SD = 4.14). The multivariate regression analyses showed that mental and physical health problems, long-term living with HIV, having a high degree of needed support, and financial problems decreased quality of life, and perceived available social support was an important predictor in maintaining quality of life. In addition to current offers to support mental health and social networks, efforts to integrate people of working age into the labor market and efforts to reduce stigma and the social marginalization of older HIV-positive people should be fostered.

Somatische Kultur und HIV-Schutzstrategien heterosexueller Männer

Summary. Somatic culture and HIV protection strategies of heterosexual menObjectives: This qualitative study examines the association between the somatic culture of heterosexual men and their choice of a protection strategy against HIV/Aids. Methods: Verbal data was generated in 23 specific interviews with Swiss German men in the age between 25 and 65 years. The analysis was based on an integration of open coding and documentary interpretation. Contrasting and systematic comparison of the cases led to a classification into types, on the basis of which the major research question could be examined. Results: The study identifies four different types of somatic cultures and demonstrates that they are highly relevant for the choice of a protection strategy against HIV/Aids. Conclusions: By introducing the concept of somatic culture as a explanatory factor, this study represents an important addition to the socio-cognitive models of protection and risk behaviour in HIV/Aids. It contributes to a theoretically broader understanding and better targeted prevention for heterosexual men.

The intention to use HIV-pre-exposure prophylaxis (PrEP) among men who have sex with men in Switzerland: testing an extended explanatory model drawing on the unified theory of acceptance and use of technology (UTAUT)

AimThe aim of this study was to determine the intention to use pre-exposure prophylaxis (PrEP) when available and to identify predictors of the intention to use PrEP among men who have sex with men (MSM) living in Switzerland. The theoretical model drew on the Unified Theory of Acceptance and Use of Technology and considered additional variables related specifically to PrEP, HIV protection and the resources of MSM.Subject and methodsFor data collection, we used an anonymous, standardized self-administered online questionnaire. In 2015, we gathered a convenience sample of 556 HIV-negative MSM living in Switzerland. We analyzed the data using descriptive and bivariate statistics and used structural equation modeling to test the hypothesized model.ResultsPredictors of respondents’ moderate intention to use PrEP were performance expectancy, effort expectancy, perceived social influence, concerns about using PrEP, attitudes toward condom use, negative experiences of condom use and age. These variables were predicted by HIV protection-related aspects and resources.ConclusionThe findings provide insights into the complex dynamic underlying the intention to use PrEP.

Settings, Sexual Practices, and Personal HIV Protection Strategies: The Circumstances of Recent HIV Infections in Switzerland

The authors investigated the circumstances of recent HIV infections in Switzerland. Their aim was to identify the interactions between individuals’ personal HIV protection strategies, their actual risk behavior, and situational factors during the high-risk event. Semi-structured interviews were conducted with 32 recently infected persons aged 21–64. Data analysis followed the principles of Grounded Theory. Interviews revealed that respondents adopted the safer sex strategy, risk reduction strategies, a priori ineffective HIV protection strategies, and alternating HIV protection strategies. Some, however, adopted no explicit protection strategy. Risk reduction strategies mirrored discourses circulating within men who have sex with men subcultures as well as messages about noninfectiousness while on treatment. Safer sex had failed due to situational or relational factors. In the case of the other strategies, infections resulted from the risk inherent in these strategies. Results show the influence of discourses about risk reduction strategies and noninfectiousness under antiretroviral treatment on personal HIV protection strategies.