Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: An Information—Motivation—Behavioral Skills Model analysis.

Kiene, Susan M.; Fisher, William A.; Shuper, Paul A.; Cornman, Deborah H.; Christie, Sarah; MacDonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Fisher, Jeffrey D.

doi:10.1037/a0030554

Cited by 24 publications

(26 citation statements)

References 21 publications

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“…Participating PLWH completed an isiZulu or English touchscreen-based audio computer-assisted self-interview (ACASI) that assessed vaginal and anal sex during the past 4 weeks, and potential correlates of risk including demographics, comorbidities (e.g., alcohol use, 24 perceived physical and mental health, 25 and depression 26 ), information-motivation-behavioral skills (IMB) model constructs, and other behavioral factors (e.g., HIV-related stigma, perceived power to use/negotiate condoms) (see 22,27,28 for details). For IMB constructs, “information” items assessed HIV prevention-related knowledge; “motivation” items identified condom-related attitudes and supportive norms for condom use; and “behavioral skills” items queried perceived skills and efficacy regarding the performance of HIV-preventive acts.…”

Section: To the Editorsmentioning

confidence: 99%

One in 4 HIV-Positive South Africans Awaiting ART Initiation Report Condomless Sex With a Serodiscordant Partner

Shuper

Pillay

MacDonald

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: To the Editorsmentioning

confidence: 99%

One in 4 HIV-Positive South Africans Awaiting ART Initiation Report Condomless Sex With a Serodiscordant Partner

Shuper

Pillay

MacDonald

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Participants were dichotomized into those who reported not having any unprotected sex with a HIV-negative/unknown partner (0) versus those who reported having unprotected sex with at least one HIV-negative/unknown partner (1) in the last four weeks. They were also dichotomized into those who reported not having any unprotected sex with an HIV-positive partner (0) versus those who reported having unprotected sex with at least one HIV-positive partner (1) in the last four weeks (Kiene et al, 2013; Shuper et al, in press). Of the total sex acts reported, 19.7% involved unprotected sex with a HIV-negative/unknown partner and 20.7% involved unprotected sex with a HIV-positive partner.…”

Section: Methodsmentioning

confidence: 99%

HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms

et al. 2014

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Social and structural factors including HIV stigma are theorized to drive global disparities in HIV prevalence. This study tests whether HIV self-stigma, or experiences of stigma at the individual level, is associated with engagement in unprotected sex among PLWH in KwaZulu-Natal, South Africa, where 37.4% of adults are living with HIV compared with 0.8% worldwide. It further explores whether depressive symptoms, HIV status disclosure to sex partners, and/or condom use attitudes mediate potential associations between HIV self-stigma and unprotected sex. Participants, including 924 PLWH, were recruited from primary care clinics and completed baseline, 6-, 12-, and 18- month survey assessments between 2008 and 2011. Hierarchical linear modeling analyses were used to examine longitudinal within-subjects associations between HIV self-stigma, mediators, and unprotected sex with both HIV-negative/unknown and HIV-positive partners. Results demonstrate that HIV self-stigma was prospectively associated with greater likelihood of unprotected sex with HIV-negative/unknown partners. None of the variables explored significantly mediated this association. HIV self-stigma was also prospectively associated with greater likelihood of unprotected sex with HIV-positive partners via the mediators of greater depressive symptoms and more negative condom use attitudes. The current study suggests that HIV self-stigma undermines HIV secondary prevention and care efforts among PLWH in KwaZulu-Natal. It is therefore critical to address HIV stigma at the social/structural level to reduce HIV self-stigma at the individual level and ultimately curb global disparities in HIV prevalence. In the absence of widespread social/structural change, interventions that treat depressive symptoms and encourage more positive condom use attitudes despite the existence of HIV stigma may buffer associations between HIV self-stigma and unprotected sex with HIV-positive partners among PLWH in KwaZulu-Natal.

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“…The IMB model targets information, motivation and behavioural skill factors that are conceptually and empirically related to HIV risk and preventive behaviours (see Fig. 1) (15) and has been effectively tested in research among diverse populations worldwide (16,17) . The IMB model has three main assumptions.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information–Motivation–Behavioural Skills model-based pilot intervention

Tuthill

Butler

Pellowski

et al. 2017

Public Health Nutr.

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Objective: Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women. Design: The Information-Motivation-Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial. Setting: Pietermaritzburg, South Africa, at two comparable rural public health service clinics. Subjects: Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum. Results: While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm. Conclusions: Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour. KeywordsExclusive breast-feeding HIV Infant feeding Information-MotivationBehavioural Skills South Africa Mother-to-child transmission of HIV Health benefits from breast-feeding positively impact mothers and provide unparalleled benefit for their infants, including reductions in morbidity (1)(2)(3) and improved survival (1) . Currently, the WHO and UNICEF recommend breast-feeding initiation within the first hours after birth; exclusive breast-feeding (EBF; i.e. feeding only breast milk and no other fluids or foods) for the first 6 months; and continued breast-feeding for up to 2 years or more (4) . EBF is also recommended for HIV-infected women living in resource-limited settings (5) . Among women on antiretroviral therapy (ART), current evidence shows that EBF with ART reduces the risk of HIV infection while increasing HIV-free infant survival compared with mixed-feeding (i.e. feeding breast milk and other foods or fluids) (6) . Specifically, during the postpartum period, ART coupled with EBF practice can reduce mother-to-child transmission of HIV from 25 % to less than 5 % (7) with some studies showing this decrease to less than 2 %. Given the benefits of breast-feeding and the n...

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Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: An Information—Motivation—Behavioral Skills Model analysis.

Cited by 24 publications

References 21 publications

One in 4 HIV-Positive South Africans Awaiting ART Initiation Report Condomless Sex With a Serodiscordant Partner

One in 4 HIV-Positive South Africans Awaiting ART Initiation Report Condomless Sex With a Serodiscordant Partner

HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information–Motivation–Behavioural Skills model-based pilot intervention

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