Jemmott John B, Jemmott Loretta Sweet, O'Leary Ann, Icard Larry D, Rutledge Scott E, Stevens Robin, Hsu Janet, Stephens Alisa J
Annenberg School for Communication and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA, 19104-3309, USA,
AIDS Behav. 2015 Jul;19(7):1247-62. doi: 10.1007/s10461-014-0961-2.
We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM's condom use are discussed.
我们对“为自己负责”(BRO)这一干预措施的效果及中介作用进行了研究。BRO是一项针对与男性发生性行为的非裔美国男性(MSM)的降低艾滋病毒/性传播感染风险的干预措施,该群体是美国艾滋病毒诊断率最高的人群。我们将非裔美国男男性行为者随机分为两种干预措施之一:以使用安全套为目标的BRO艾滋病毒/性传播感染风险降低干预措施;或以体育活动和健康饮食为目标的注意力匹配对照干预措施。这些干预措施基于社会认知理论、理性行动方法和定性研究。报告在过去90天内与其他男性发生过肛交的男性符合条件,并完成了干预前、干预后立即以及干预后6个月和12个月的调查。在595名参与者中,503名(85%)完成了12个月的随访。广义估计方程分析表明,与注意力匹配对照干预措施相比,BRO干预措施在6个月和12个月随访期间平均并未增加持续使用安全套的情况,而这是主要结果。尽管BRO并未影响受安全套保护的性交行为、无保护性交、多个性伴侣或插入式肛交的比例,但与对照组相比,它确实减少了接受性肛交,而这种行为与艾滋病毒感染事件有关。使用系数乘积法进行的中介分析表明,尽管BRO增加了其旨在影响的九个理论构念中的七个,但它只增加了预测持续使用安全套的三个理论构念中的一个:安全套使用冲动控制自我效能感。因此,BRO通过安全套使用冲动控制自我效能感间接增加了持续使用安全套的情况。总之,尽管BRO增加了几个理论构念,但这些构念中的大多数并未预测持续使用安全套的情况;因此,该干预措施并未增加持续使用安全套的情况。本文讨论了干预措施应针对哪些理论构念来增加非裔美国男男性行为者使用安全套的情况。
Natl Vital Stat Rep. 2013-12-20
Proc Natl Acad Sci U S A. 2012-8-27