Yixuan Li,Xueling Xiao,Ziqi Qin,Yuqiong Duan,Qiaoyue Lu,Nancy R Reynolds,Honghong Wang,Wenru Wang
{"title":"Changed Personal Attitudes Predict Sexual Behaviours Among Men Living With HIV in the Era of U=U: A Half-Longitudinal Study.","authors":"Yixuan Li,Xueling Xiao,Ziqi Qin,Yuqiong Duan,Qiaoyue Lu,Nancy R Reynolds,Honghong Wang,Wenru Wang","doi":"10.1111/jan.70221","DOIUrl":null,"url":null,"abstract":"INTRODUCTION\r\nIn the era of 'Undetectable = Untransmittable' (U=U), reductions in condom use and increases in casual partnerships may contribute to elevated risks of coinfection with other sexually transmitted infections (STIs) and HIV super-infections among men living with HIV. These trends may reflect a shift in personal attitudes towards sexual behaviour and HIV risk, yet their influence on actual behaviours remains unclear.\r\n\r\nAIM\r\nTo investigate how changes in personal attitudes and safe sex self-efficacy influence sexual decision-making.\r\n\r\nDESIGN\r\nTwo-wave longitudinal study design.\r\n\r\nMETHODS\r\nWe conducted a 3-month longitudinal study from March to December 2023 among HIV-positive men (≥ 18 years) initiating ART in Changsha, China. Cross-lagged panel analysis and half-longitudinal mediation analysis were used to examine how changes in personal attitudes influenced sexual behaviours.\r\n\r\nRESULTS\r\n427 men living with HIV were included at baseline, and 301 completed the follow-up survey. Sexual behaviours were associated with personal attitudes, namely safe sex fatigue, viral load/transmission beliefs, and sexual sensation seeking. More positive personal attitudes in these domains at baseline predicted lower safe sex self-efficacy over 3 months, while reduced baseline self-efficacy increased the likelihood of engaging in condomless sex and/or multiple sexual partners. All three personal attitude domains had significant indirect effects on sexual behaviours via safe sex self-efficacy.\r\n\r\nCONCLUSION\r\nIn the era of U=U, the changed personal attitudes among men living with HIV may lead to the increased likelihood of engaging in condomless sex and/or having multiple sexual partners, and safe sex self-efficacy serves as a mediator in this relationship.\r\n\r\nIMPACT\r\nThis study highlights the potential influence of attitudinal changes on sexual behaviours among men living with HIV in the 'U=U' era. Findings provide valuable evidence for developing more targeted interventions that address not only behavioural outcomes but also underlying personal attitudes.\r\n\r\nPATIENT OR PUBLIC CONTRIBUTION\r\nNo patient or public contribution.","PeriodicalId":54897,"journal":{"name":"Journal of Advanced Nursing","volume":"36 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Advanced Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jan.70221","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 0
Abstract
INTRODUCTION
In the era of 'Undetectable = Untransmittable' (U=U), reductions in condom use and increases in casual partnerships may contribute to elevated risks of coinfection with other sexually transmitted infections (STIs) and HIV super-infections among men living with HIV. These trends may reflect a shift in personal attitudes towards sexual behaviour and HIV risk, yet their influence on actual behaviours remains unclear.
AIM
To investigate how changes in personal attitudes and safe sex self-efficacy influence sexual decision-making.
DESIGN
Two-wave longitudinal study design.
METHODS
We conducted a 3-month longitudinal study from March to December 2023 among HIV-positive men (≥ 18 years) initiating ART in Changsha, China. Cross-lagged panel analysis and half-longitudinal mediation analysis were used to examine how changes in personal attitudes influenced sexual behaviours.
RESULTS
427 men living with HIV were included at baseline, and 301 completed the follow-up survey. Sexual behaviours were associated with personal attitudes, namely safe sex fatigue, viral load/transmission beliefs, and sexual sensation seeking. More positive personal attitudes in these domains at baseline predicted lower safe sex self-efficacy over 3 months, while reduced baseline self-efficacy increased the likelihood of engaging in condomless sex and/or multiple sexual partners. All three personal attitude domains had significant indirect effects on sexual behaviours via safe sex self-efficacy.
CONCLUSION
In the era of U=U, the changed personal attitudes among men living with HIV may lead to the increased likelihood of engaging in condomless sex and/or having multiple sexual partners, and safe sex self-efficacy serves as a mediator in this relationship.
IMPACT
This study highlights the potential influence of attitudinal changes on sexual behaviours among men living with HIV in the 'U=U' era. Findings provide valuable evidence for developing more targeted interventions that address not only behavioural outcomes but also underlying personal attitudes.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
期刊介绍:
The Journal of Advanced Nursing (JAN) contributes to the advancement of evidence-based nursing, midwifery and healthcare by disseminating high quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy.
All JAN papers are required to have a sound scientific, evidential, theoretical or philosophical base and to be critical, questioning and scholarly in approach. As an international journal, JAN promotes diversity of research and scholarship in terms of culture, paradigm and healthcare context. For JAN’s worldwide readership, authors are expected to make clear the wider international relevance of their work and to demonstrate sensitivity to cultural considerations and differences.