Title

Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities-HPTN 073

Authors

LaRon E. Nelson, School of Nursing, Yale University, 400 West Campus Drive, New Haven, CT, USA. laron.nelson@yale.edu.
Donte T. Boyd, Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, New Haven, CT, USA.
Geetha Beauchamp, Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Lynda Emel, Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Leo Wilton, Department of Human Development, College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA.
Darren Whitfield, School of Social Work, University of Maryland Baltimore, Baltimore, MD, USA.
S Raquel Ramos, School of Nursing, Yale University, 400 West Campus Drive, New Haven, CT, USA.
Wale Ajiboye, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Mandy J. Hill, Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, USA.
Donaldson F. Conserve, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Universty, Washington, DC, USA.
Portia Thomas, Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, New Haven, CT, USA.
Lisa Hightow-Weidman, Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
Steve Shoptaw, Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Manya Magnus, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Kenneth H. Mayer, The Fenway Institute, Fenway Health, Boston, MA, USA.
Estelle Piwowar-Manning, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Sheldon D. Fields, Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA.
Darrell P. Wheeler, Iona College, New Rochelle, NY, USA.

Document Type

Journal Article

Publication Date

8-8-2022

Journal

Journal of urban health : bulletin of the New York Academy of Medicine

DOI

10.1007/s11524-022-00666-y

Keywords

Autonomy support; Black MSM; Disparities; HIV; HIV Prevention Trials Network; HIV prevention; HPTN; Multi-level intervention; Multicomponent intervention; Path analysis; PrEP; Self-determination theory; Sexually transmitted infection; Structural equation modeling Condom use

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 (χ = 0.56; RMSEA = 0.04; CFI = .99, TLI = 0.98) and how it also leads to decreased odds of condomless anal intercourse (χ = 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.

Department

Prevention and Community Health

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