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Association of Condom Use Advocacy with Perceived Condom Use Among Social Network Members: The Mediating Role of Advocates’ Internalized HIV Stigma and Own Condom Use

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Abstract

We examined the association of HIV prevention advocacy with social network members (alters) on alter condom use behavior, and factors that may mediate and moderate this relationship, among people living with HIV (PLWH) in Uganda. Ninety PLWH completed all assessments (baseline and 5- and 8-month follow-ups). Internalized HIV stigma, HIV disclosure self-efficacy, positive living behavior (i.e., condom use), and advocacy self-efficacy were examined as mediators (at 5-month follow-up) of the association between condom use advocacy and perceived alter condom use. Individual socio-demographic and social network characteristics at baseline were examined as moderators. Among alters who received condom use advocacy in the months prior to both baseline and 5-month follow-up, 69.9% (51/73) were perceived to mostly/always use condoms at either the 5- or 8-month follow-up, which was significantly higher than the 36.4% (235/645) of alters who received none or less advocacy. Participants’ internalized HIV stigma and consistent condom use mediated the association of advocacy and perceived consistent condom use among alters; the participant having any secondary education and the alter being male were associated with increased magnitude of the associations between advocacy and alter condom use. These findings highlight the importance of sustained advocacy to promote consistent condom use, and the value of anti-stigma and positive living interventions as mechanisms for enhancing effective advocacy.

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Data Availability

De-identified dataset and statistical code are available to researchers upon submission of proposal and review by the study team.

Material Availability

De-identified dataset and statistical code are available to researchers upon submission of proposal and review by the study team.

Code Availability

De-identified dataset and statistical code are available to researchers upon submission of proposal and review by the study team.

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Funding

This study was funded by the National Institute of Mental Health (R34 MH111460, P30 MH058107).

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Authors and Affiliations

  1. RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA

    Glenn J. Wagner, Laura M. Bogart, David J. Klein & Harold D. Green

  2. Makerere University School of Public Health, Kampala, Uganda

    Joseph K. B. Matovu

  3. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda

    Joan Nampiima, Andrew Kambugu & Joseph K. B. Matovu

  4. University of Indiana Bloomington School of Public Health, Bloomington, IN, USA

    Harold D. Green

Authors
  1. Glenn J. Wagner
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  2. Laura M. Bogart
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  3. David J. Klein
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  4. Harold D. Green
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  5. Joan Nampiima
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  6. Andrew Kambugu
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  7. Joseph K. B. Matovu
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by JM and LB. Data analysis was performed by DK and GW. The first draft of the manuscript was written by GW and all authors commented on prior versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Glenn J. Wagner.

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The authors declare that they have no conflict of interest.

Ethical Approval

Approval was obtained from the institutional review boards at the RAND Corporation and the Infectious Diseases Institute. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study. Consent to publication is not applicable.

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Wagner, G.J., Bogart, L.M., Klein, D.J. et al. Association of Condom Use Advocacy with Perceived Condom Use Among Social Network Members: The Mediating Role of Advocates’ Internalized HIV Stigma and Own Condom Use. AIDS Behav 26, 2485–2493 (2022). https://doi.org/10.1007/s10461-022-03601-z

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