The Mechanism of Theory-based HIV Behavioral Intervention on Condom Use among Rural-to-urban Migrants in China: The Mediating Roles of HIV Knowledge and Condom Use Self-efficacy

Abstract

Previous studies have suggested HIV knowledge and self-efficacy are important cognitive factors that might influence condom use behaviors. However, data were limited regarding their mediating effects on condom use during behavioral interventions. This study examined the mechanistic roles of these two factors on the effect of a community-based intervention aiming to increase condom use behaviors and intention among young rural-to-urban migrants in China. Data were derived from a community-based HIV behavioral intervention trial among 639 young sexually active rural-to-urban migrants in Beijing, China. Path analyses were used to examine the direct and indirect effects of the intervention program on condom use behaviors and intention over a 12-month follow-up. HIV knowledge and condom use selfefficacy at 6-month follow-up served as mediators in models. Path analyses revealed that intervention program increased condom use behaviors at 12 months through the increase of HIV knowledge at 6 months. Likewise, the intervention program increased condom use intention through the increases of HIV knowledge and condom use self-efficacy. The results suggested HIV knowledge played an important mediating role on the effect of the intervention program on condom use behaviors and intention. Additionally, condom use self-efficacy played an important role in increasing condom use intention. To increase condom use behaviors and intention among migrants, future studies are warranted that focus on improving HIV knowledge and helping migrants overcome cognitive barriers of condom use. Other efforts targeting structural and environmental barriers, such as limited healthcare access due to household registration status, are also needed to increase HIV protective behaviors.