Coping Self-Efficacy and HIV Sexual Transmission Risk Behavior in a Clinic-Based Cohort of HIV-Positive Men

BACKGROUND: Coping self-efficacy has been associated with risky sexual behavior among HIV-positive men who have sex with men (MSM). Few studies have evaluated this relationship among clinic-based populations, or among men who have sex with women (MSW). METHODS: We conducted an analysis of survey data from 594 HIV-positive men receiving care at one of two clinic sites between 5/04 to 10/06. Coping self-efficacy was measured using a 9-item 7-point scale adapted from a previously validated scale. We compared means of total coping self-efficacy scores across protected vs. unprotected vaginal or anal sex with HIV-negative or unknown status partners, stratified by MSW and MSM. Multivariate logistic regression was performed to adjust for confounding variables. RESULTS: Coping self-efficacy was not associated with any HIV transmission risk behaviors for MSW. However, low coping self-efficacy was associated with receptive anal sex (N=110, unprotected mean(sd)= 44(11), protected=49(9), p=0.008) and insertive anal sex (N= 82, unprotected mean(sd)= 39(13), protected=50(10), p=0.0001) for MSM. Multivariate logistic regression models adjusting for ethnicity, education level, income, age, relationship status, and illicit substance use showed that every 1 SD increase in coping self-efficacy was associated with a decreased likelihood of engaging receptive anal sex (OR=0.56, 95% CI: 0.34-0.92) and insertive anal sex (OR=0.38, 95% CI: 0.21-0.70). CONCLUSIONS: Coping self-efficacy is associated with HIV sexual transmission risk behavior, though it may be more important for MSM than for other risk groups. Clinic-based behavioral interventions should target coping self-efficacy, particularly among MSM.