259632 Pre-diagnosis predictors of risk reduction after diagnosis among MSM receiving care in Tijuana

Monday, October 29, 2012

Carol L. Sipan, RN, MPH, PhD , Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University and University of CA, Merced, San Diego, CA
Melbourne F. Hovell, PhD, MPH , San Diego State University, Graduate School of Public Health, San Diego, CA
Claudia Carrizosa, MD, MPH , Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
Christina Chambers, PhD, MPH , Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA
Ming Ji, PhD , Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA
John Weeks, PhD , Department of Geography, and Director, International Population Center, San Diego State University, San Diego, CA
Theodore Ganiats, MD , Family and Preventive Medicine, School of Medicine, University of California, La Jolla, CA
Marie Boman, MPH, ABD , Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
Background: The development of effective transmission risk reduction strategies among PLWHA requires greater understanding of behavioral determinants. Little is known about pre-diagnosis predictors of behavior change after diagnosis for any population. Methods: A secondary analysis was conducted using data collected in Tijuana for a study of determinants of late HIV testing. One hundred and eight men who have sex with men were classified as 0=no sexual risk behavior change or 1=reduction from moderate/high to no/low risk after diagnosis. Potential predictors were selected from pre-diagnosis data. Results: Over 60% decreased risk behavior from moderate/high risk to no/low risk; 38.9% remained at moderate/high risk. A logistic regression model significantly explained an estimated 28.4% (Nagelkerke R2) of the variance in reported sexual risk behavior reduction, x2(9, N=106)=24.93, p<0.01. One variable and two interaction terms were significant independent predictors of reported decreased sexual risk behavior post-diagnosis (p<0.05) after accounting for the other variables in the model: having a close relationship with a sexual partner pre-diagnosis (AOR 2.18 [95% CI .890-5.356] p=0.008), the interaction between peer risk behavior and having a close relationship with a sexual partner pre-diagnosis (AOR 0.85 [95% CI 0.8500.852] p=.024); and the interaction between the number of years living in a high HIV prevalence environment and education level (AOR 1.03 [95% CI 1.0291.030] p=.023). Age at HIV diagnosis, asymptomatic at diagnosis, and peer risk index were near-significant (p<0.10). Conclusions: Pre-existing social environmental factors appear important to determining risk reduction post-diagnosis. Additional studies are needed to understand these dynamics.

Learning Areas:
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related nursing
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1)Explain the importance of considering pre-diagnosis predictors of behavior change post-diagnosis. 2)Identify measures to consider when designing tools for risk reduction needs assessment at the time of HIV+ diagnosis.

Keywords: HIV Risk Behavior, Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The study constituted part of my doctoral dissertation. I have been involved in HIV surveillance and intervention research since 1988. Among my scientific interests has been the testing of a behavioral ecological mode for application in HIV control efforts. I have participated on community HIV prevention planning groups since 1995, both at the state and county levels.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.