Social Cognitive Influences on HIV vs. STI Testing Behaviors


Background. Rates of common bacterial sexually transmitted infections (STIs) are at an all-timereported high in the United States, while rates of new human immunodeficiency virus (HIV) infections are declining. Among HIV-negative men and transgender women who have sex with men, whom are theoretically at risk for both HIV and bacterial STI infection, more than twice as many individuals report being tested for HIV in the last year than report being tested for other STIs. Understanding the factors that influence HIV testing and how those factors differ from those that influence STI testing could help explain this disparity in testing rates. The present study proposes a social cognitive model of HIV and STI testing behavior based on Social Cognitive Theory. Method. Participants were HIV-negative adults who endorsed male assigned sex at birth and identify as a sexual or gender minority (n = 164) who completed a health needs survey in a region where HIV and STI rates are among the highest in the nation. Structural equation modeling was used to test the proposed social cognitive model separately with HIV and STI testing outcomes. Several additional models specified in advance were also tested using the same procedure. Results. The social cognitive model and all a priori modifications to it were found to be poor fits for both HIV and STI testing outcomes. Post hoc models were created in response to these results and tested in the same manner. All post hoc models were also found to be a poor fit for both HIV and STI testing outcomes. Conclusions. Analyses failed to identify social cognitive models that were a good fit for either HIV or STI testing behavior. The study suffered from several limitations, including being underpowered, significantly limiting the interpretation of the statistical results. These limitations are discussed and recommendations are made for future studies that intend to use theoretical models to understand the differences in HIV and STI testing behaviors.

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