Longitudinal Predictors of Behavioral Intentions and HIV Service Use Among Men Who Have Sex with Men

HIV prevention interventions are generally effective at reducing sexual risk. Although these interventions have been widely disseminated in the USA, their success depends largely on whether subpopulations who have been prioritized for risk reduction are willing to participate. Understanding the factors predicting service utilization is critical to maximizing public health benefit. HIV-negative men who have sex with men (MSM) (n = 613) were enrolled in a longitudinal study investigating whether theoretically derived psychosocial variables (past behavior, cues to action, perceived susceptibility, positive expectations, perceived barriers, personal discomfort, and recent condomless anal intercourse) predicted intentions to use HIV prevention services and service use behavior across multiple categories (information seeking, structured service use, HIV testing, and volunteering/working in prevention services). Cues to action (including life events such as friend's recent HIV diagnosis) and past service use emerged as the most consistent predictors of intentions and actual service use. Perceived susceptibility, positive expectations, and condomless anal intercourse predicted some categories of service use indirectly through intentions. Contrary to predictions, perceived barriers and personal discomfort predicted intentions but were not predictors of service use. Intentions generally predicted behavior, with the exception of structured service use. This study addressed methodological limitations of prior research and utilized data from a longitudinal sample of MSM to discover predictors of access to HIV prevention services. Understanding who accesses HIV services and why will allow for directed strategies to improve dissemination and utilization.