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These trends may reflect a shift in personal attitudes towards sexual behaviour and\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      risk, yet their influence on actual behaviours remains unclear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate how changes in personal attitudes and safe sex self\u2010efficacy influence sexual decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Two\u2010wave longitudinal study design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a 3\u2010month longitudinal study from March to December 2023 among\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      \u2010positive men (\u2265\u200918\u2009years) initiating\n                      <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>\n                      in Changsha, China. Cross\u2010lagged panel analysis and half\u2010longitudinal mediation analysis were used to examine how changes in personal attitudes influenced sexual behaviours.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      427 men living with\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      were included at baseline, and 301 completed the follow\u2010up survey. Sexual behaviours were associated with personal attitudes, namely safe sex fatigue, viral load\/transmission beliefs, and sexual sensation seeking. More positive personal attitudes in these domains at baseline predicted lower safe sex self\u2010efficacy over 3\u2009months, while reduced baseline self\u2010efficacy increased the likelihood of engaging in condomless sex and\/or multiple sexual partners. All three personal attitude domains had significant indirect effects on sexual behaviours via safe sex self\u2010efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In the era of U=U, the changed personal attitudes among men living with\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      may lead to the increased likelihood of engaging in condomless sex and\/or having multiple sexual partners, and safe sex self\u2010efficacy serves as a mediator in this relationship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>This study highlights the potential influence of attitudinal changes on sexual behaviours among men living with HIV in the \u2018U=U\u2019 era. Findings provide valuable evidence for developing more targeted interventions that address not only behavioural outcomes but also underlying personal attitudes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patient or public contribution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.70221","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T12:01:41Z","timestamp":1757937701000},"page":"5967-5979","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Changed Personal Attitudes Predict Sexual Behaviours Among Men Living With HIV in the Era of U=U: A Half\u2010Longitudinal Study"],"prefix":"10.1111","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0333-9838","authenticated-orcid":false,"given":"Yixuan","family":"Li","sequence":"first","affiliation":[{"name":"Xiangya School of Nursing Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8810-9291","authenticated-orcid":false,"given":"Xueling","family":"Xiao","sequence":"additional","affiliation":[{"name":"Xiangya School of Nursing Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqi","family":"Qin","sequence":"additional","affiliation":[{"name":"Xiangya School of Nursing Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqiong","family":"Duan","sequence":"additional","affiliation":[{"name":"Xiangya School of Nursing Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoyue","family":"Lu","sequence":"additional","affiliation":[{"name":"Xiangya School of Nursing Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy R.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Nursing  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3484-8929","authenticated-orcid":false,"given":"Honghong","family":"Wang","sequence":"additional","affiliation":[{"name":"Xiangya School of Nursing Central South University  Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-8215","authenticated-orcid":false,"given":"Wenru","family":"Wang","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine National University of Singapore  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2008.031351"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.15171\/Hpp.2017.14"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12919\u2010020\u201000200\u20105"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03296-8"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2017.1360994"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(23)00877\u20102"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab582"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(19)30030\u2010X"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcli.2011.07.020"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiac166"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/2631831818822015"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508\u2010018\u20101207\u20106"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461\u2010017\u20101950\u2010z"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021\u2010843x.112.4.558"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/0954012031000134755"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334\u2010200304150\u201000013"},{"key":"e_1_2_10_18_1","volume-title":"The Relationship Between HIV Knowledge, Impulsivity, Delay of Gratification, and Sexual Attitudes to Risky Sexual Behaviors in Female African American Undergraduate Students","author":"Cumberland M. 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