Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in ... View Full Text


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Article Info

DATE

2022-08-08

AUTHORS

LaRon E. Nelson, Donte T. Boyd, Geetha Beauchamp, Lynda Emel, Leo Wilton, Darren Whitfield, S. Raquel Ramos, Wale Ajiboye, Mandy J. Hill, Donaldson F. Conserve, Portia Thomas, Lisa Hightow-Weidman, Steve Shoptaw, Manya Magnus, Kenneth H. Mayer, Estelle Piwowar-Manning, Sheldon D. Fields, Darrell P. Wheeler

ABSTRACT

Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client’s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N = 226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (χ2 = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ2 = 0.58; RMSEA = 0.03; CFI = 0.99; TLI = 0.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men. More... »

PAGES

1-13

References to SciGraph publications

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  • 2022-01-26. Client-Centered Care Coordination (C4™) for HIV/STI Prevention: a Theoretical, Conceptual, and Methodological Overview—HIV Prevention Trials Network (HPTN) 073 in SEXUALITY RESEARCH AND SOCIAL POLICY
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  • Journal

    TITLE

    Journal of Urban Health

    ISSUE

    N/A

    VOLUME

    N/A

    Author Affiliations

  • MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
  • College of Social Work, The Ohio State University, Columbus, OH, USA
  • Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
  • Department of Humanities, University of Johannesburg, Johannesburg, South Africa
  • School of Social Work, University of Maryland Baltimore, Baltimore, MD, USA
  • Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, New Haven, CT, USA
  • Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA
  • Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Universty, Washington, DC, USA
  • Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
  • Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
  • Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
  • Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
  • The Fenway Institute, Fenway Health, Boston, MA, USA
  • Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  • Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
  • Iona College, New Rochelle, NY, USA
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11524-022-00666-y

    DOI

    http://dx.doi.org/10.1007/s11524-022-00666-y

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1150070013

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35939181


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        "description": "Abstract\nHealthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client\u2019s motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive for engaging in health behaviors. It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic\u00a0psychological needs for autonomous self-regulation and competence regarding pre-exposure prophylaxis use. We also investigated whether autonomy support was associated with decreased odds of condomless anal intercourse via the same psychological needs-satisfaction pathway of autonomous self-regulation and competence\u00a0regarding condom use. We tested these two theorized pathways using secondary data from a longitudinal sample of Black men who have sex with men from across three cities in the US (N\u2009=\u2009226). Data from the sample fit the theorized models regarding the pathways by which autonomy support leads to the presence of therapeutic PrEP levels in serum (\u03c72\u2009=\u20090.56; RMSEA\u2009=\u20090.04; CFI\u2009=\u2009.99, TLI\u2009=\u20090.98) and how it also leads to decreased odds of condomless anal intercourse (\u03c72\u2009=\u20090.58; RMSEA\u2009=\u20090.03; CFI\u2009=\u20090.99; TLI\u2009=\u20090.98). These findings provide scientific evidence for the utility of self-determination theory as a model to guide intervention approaches to optimize the implementation and impact of PrEP for Black men who have sex with men.", 
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