Introduction 1999 2000 2002 2004 2003 2002 2004 2002 other one’s own 1999 2005 2005 2000 2005 1999 2003 2005 1991 1977 1981 1998 Theory of Planned Behavior 1991 1986 1996 2001 2001 1999 1977 Norm-Activation Theory 1977 1981 1996 awareness of need ascription of responsibility efficacy ability Sexual motives for unprotected anal sex 1998 2005 2000 2005 2000 Proposed model of sexual decision-making 1 1998 Fig. 1 Proposed model of sexual decision-making  Method Participants Data were obtained by means of a self-administered questionnaire between July 2002 and April 2003. Participants were recruited through AIDS consultants working in 15 Dutch hospitals. Participants were asked to fill out the questionnaire at home and return the questionnaires directly to the research institution by means of a stamped, pre-addressed envelope. Consequently, no information was available about the response rate per hospital. Participation was on a voluntary and anonymous basis. A pilot study indicated that completion of the questionnaire took about 30 to 45 min. Participants received no compensation for filling out the questionnaires. Approval for the study was obtained from the Ethics Committee of Maastricht University Hospital. Participants who met the following criteria were included in the study: (1) tested positive for HIV-antibodies; (2) identified themselves as homosexual or bisexual; (3) aged between 20 and 65 years; and (4) were sufficiently fluent in Dutch to complete the questionnaire. A total of 1,050 questionnaires were distributed, of which 296 were completed and returned (response rate = 28.2%). 1 Table 1 N Characteristics N % Nationality  Dutch 251 85.7  Surinam/Antillean  5 1.7  Other 37 12.6 Geographic area of the Netherlands  Amsterdam 73 25.3  West (excluding Amsterdam) 110 38.0  South 67 23.2  Northeast 39 13.5 Age  25–35 55 18.9  36–45 136 46.7  46–55 82 28.2  >56 18 6.2 Education  Higher vocational education or university 124 43.1  Secondary vocational training or high school 120 41.7  Primary school or basic vocational training 34 11.8  Other 10 3.5 Employment status  Full-time 117 43.5  Part-time 80 29.7  Unemployed 72 26.8 Self-identification  Homosexual 244 82.4  More homosexual than heterosexual 38 12.8  Bisexual  8 2.7  More heterosexual than bisexual  4 1.4  Other  2 0.7 Years knowing HIV-positive status  <2 yrs 59 20.1  2–6 yrs 116 39.6  7–11 yrs 71 24.2  12–16 yrs 37 12.6  >16 yrs 10 3.4 Self-reported CD4+  <200 33 11.1  200–500 120 40.5  >500 92 31.1  Don’t know 51 17.2 Self-reported viral load    Detectable [median=10.000, range 50–2.080.000 72 25.9  Undetectable 176 63.3  Don’t know 30 10.8 Antiviral treatment  No 59 20.1  Yes 234 79.9 Measures 2000 2005 Attitudinal beliefs 2005 2000 Subjective norms 1973 Self-efficacy 2005 2000 Personal norms 1996 1995 awareness of consequences for self awareness of consequences for others Ascription of responsibility yourself Sexual motives in press Intention sexual risk behavior Results Sexual behavior 2 Table 2 N  N %  178 60.1  124 (178) 69.7  42 (178) 23.6  41 (42) 97.6  91 (178) 51.1  44 (91) 48.4  214 72.3  167 (214) 78.0  68 (214) 31.8  68 (68) 100.0  160 (214) 74.8  73 (160) 45.6    177 (214) 82.8  189 (214) 88.3 2 p 2 Descriptive statistics and correlations SD 3 Table 3 N N Scale Range (1) (2) (3) (4) (5) (6) (7) (8) (9) Intention (1) 1–5 – ** ** ** ** ** ** ** ** Attitudinal beliefs (2) 1–5 ** – ** ** ** ** * ** ** Subjective norms (3) 1–5 ** ** – ** ** * .07 ** ** Self-efficacy (4) 1–5 ** ** ** – ** ** ** ** ** Personal norms (5) 1–5 ** ** ** ** – ** ** ** ** Awareness consequences self (6) 1–5 * ** * ** ** – ** ** ** Awareness consequences others (7) 1–5 ** ** ** ** ** ** – ** ** Ascription of responsibility (8) 1–5 ** ** ** ** ** * ** – ** Sexual motives (9) 1–7 ** ** ** ** ** * ** ** – Steady M  4.1 3.5 4.3 4.2 4.1 3.3 4.0 4.2 3.5 SD  1.3 0.7 1.0 0.9 1.4 1.6 1.4 0.7 1.6 Casual M  4.3 3.8 4.3 4.2 4.3 3.8 4.2 4.3 3.4 SD  1.1 0.6 0.6 0.8 1.1 1.2 1.2 0.8 1.4 * p ** p 1 Predictors of intended condom use 1 1986 1998 Steady sex partners 4 p p 4 p p 1986 4 4 p p Casual sex partners 5 p p p p p 5 1986 5 5 p p p Table 4 N  Model 1 Model 2 Model 3 Model 4 Model 5  B OR 95% CI B OR 95% CI B OR 95% CI B OR 95% CI B OR 95% CI Step 1  Education level .25 * 1.1–1.6 .11 1.1 .86–1.5 .07 1.1 .81–1.4 .07 1.1 .81–1.4 .01  1.0 .74–1.4 a −1.2 ** .14–.64 −.43 −.65 .24–1.8 −.40 .67 .24–1.9 −.40 .67 .23–1.9 −.35 .70 .22–2.3 Step 2  Attitudinal beliefs    .49 1.6 .67–4.0 .35 1.4 .55–3.7 .37 1.5 .53–4.0  1.1 .37–3.1  Subjective norms    .67 2.0 1.0–3.8 .61 1.8 .92–3.7 .62 1.9 .92–3.7 .07 .64 .20–2.1  Self-efficacy    1.7 *** 2.1–13.7 1.6 ** 1.7–13.6 1.6 ** 1.7–14.3 −.44 2.7 .82–8.9 Step 3 b       −.02 .98 .71–1.4 −.02 .98 .70–1.4 −.01 .99 .70–1.4 c       .24 1.3 .88–1.8 .24 1.3 .88–1.8 .22 1.3 .85–1.8 d       .29 1.3 .50–3.5 .28 1.3 .50–3.5 .21 1.2 .43–3.5 Step 4  Sexual motives          .02 1.0 .70–1.5 −.04 1.0 .65–1.4 Step 5  Personal norms             2.4 ** 2.0–57.5 2 .13   .53   .54   .54   .62   2 15.8   74.5   77.1   77.1   92.1   Note. a b c d * p ** p *** p Table 5 N  Model 1 Model 2 Model 3 Model 4 Model 5  B OR 95% CI B OR 95% CI B OR 95% CI B OR 95% CI B OR 95% CI Step 1 a .99 ** 1.4–5.2 .74 2.1 .88–5.0 1.1 * 1.1–7.3 1.1 * 1.2–8.4 1.2 * 1.2–9.2 Step 2  Attitudinal beliefs    1.2 ** 1.4–7.5 .84 2.3 .92–5.8 .32 1.4 .50–3.8 .25 1.3 .45–3.6  Subjective norms    1.1 ** 1.3–6.5 .90 2.5 1.0–6.1 .86 2.4 .91–6.1 .39 1.5 .50–4.4  Self-efficacy    1.5 *** 2.3–7.9 1.1 ** 1.5–5.9 .86 * 1.1–5.0 .53 1.7 .76–3.8 Step 3 b       .24 1.3 .85–1.9 .25 1.3 .85–2.0 .13 1.1 .72–1.8 c       .34 1.4 .89–2.2 .34 1.4 .88–2.2 .34 1.4 .86–2.3 d       1.1 * 1.2–7.5 1.1 * 1.1–7.9 .64 1.9 .65–5.5 Step 4  Sexual motives          −.61 ** .35–8.3 −.57 * .36–.89 Step 5  Personal norms             1.3 ** 1.6–8.9 2 .06   .52   .60   .63   .68   2 8.9   91.4   111.8   120.5   132.3   Note. a b c d * p ** p *** p Discussion 2002 1991 1996 1999 1998 2000 1999 1 2000 2005 2004 1970 2000 2002 1998 2000 2001 2001 2005 1997 2006