The impact of perceived stress on self-management behaviors among men who have sex with men living with HIV in China: the mediating role of self-regulatory fatigue

As a chronic disease, effective HIV self-management is crucial for men who have sex with men (MSM) living with HIV. Psychosocial factors, including perceived stress and self-regulatory fatigue, have been shown to negatively impact self-management behaviors. However, research on the relationships among perceived stress, self-regulatory fatigue, and self-management behaviors remains limited. This study aimed to explore the mediating effect of self-regulatory fatigue in the relationship between perceived stress and self-management behaviors among MSM living with HIV in China. From December 2024 to March 2025, cross-sectional data were collected from 328 MSM living with HIV at an HIV-designated hospital in Jiangsu Province using convenience sampling. Data were collected using the Perceived Stress Scale, Self-Regulatory Fatigue Scale, and HIV Self-Management Scale. Descriptive statistics, univariate analysis, and Pearson correlation analysis were performed in this study. The mediating effect of self-regulatory fatigue in the relationship between perceived stress and self-management behaviors was assessed using Model 4 of the PROCESS macro for SPSS. Among 328 MSM living with HIV, the average score of perceived stress was 30.67 ± 7.87, the average self-regulatory fatigue score was 43.99 ± 8.76, and the average HIV self-management score was 36.65 ± 7.88. Perceived stress was positively related to self-regulatory fatigue (r = 0.544, p<0.05), whereas self-management behaviors were proven to be negatively associated with perceived stress (r = -0.486, p<0.05) and self-regulatory fatigue (r = -0.504, p<0.05). Self-regulatory fatigue partially mediated the association between perceived stress and self-management behaviors, accounting for 34.39% of the total effect. This study demonstrated that self-regulatory fatigue partially mediated the relationship between perceived stress and self-management behaviors and underscored the importance of designing targeted interventions aimed at reducing perceived stress and self-regulatory fatigue to improve self-management behaviors among MSM living with HIV in China. Multidimensional strategies, achieved through collaborative efforts among patients, healthcare providers, government, and community, should incorporate personalized mental care and stress management, available social support, trained peer navigation, and consistent health education.