title: Operationalizing the Measurement of Seroadaptive Behaviors: A Comparison of Reported Sexual Behaviors and Purposely-Adopted Behaviors Among Men who have Sex with Men (MSM) in Seattle.
abstract: Seroadaptive behaviors are traditionally defined by self-reported sexual behavior history, regardless of whether they reflect purposely-adopted risk-mitigation strategies. Among MSM attending an STD clinic in Seattle, Washington 2013-2015 (N = 3751 visits), we used two seroadaptive behavior measures: (1) sexual behavior history reported via clinical computer-assisted self-interview (CASI) (behavioral definition); (2) purposely-adopted risk-reduction behaviors reported via research CASI (purposely-adopted definition). Pure serosorting (i.e. only HIV-concordant partners) was the most common behavior, reported (behavioral and purposely-adopted definition) by HIV-negative respondents at 43% and 60% of visits, respectively (kappa = 0.24; fair agreement) and by HIV-positive MSM at 30 and 34% (kappa = 0.25; fair agreement). Agreement of the two definitions was highest for consistent condom use [HIV-negative men (kappa = 0.72), HIV-positive men (kappa = 0.57)]. Overall HIV test positivity was 1.4 but 0.9% for pure serosorters. The two methods of operationalizing behaviors result in different estimates, thus the choice of which to employ should depend on the motivation for ascertaining behavioral information.
authors.affiliation: Department of Epidemiology, University of Washington, Harborview Medical Center Box 359777, 325 Ninth Avenue, Seattle, WA, USA. ckhosro@uw.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Khosropour
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.|Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.affiliation: Department of Epidemiology, University of Washington, Harborview Medical Center Box 359777, 325 Ninth Avenue, Seattle, WA, USA.|Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Manhart
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: Department of Epidemiology, University of Washington, Harborview Medical Center Box 359777, 325 Ninth Avenue, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.|Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D059147:HIV Serosorting / Q000523:psychology / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012107:Research Design; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012747:Sexual Partners; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; Men who have sex with men; Seroadaptive behaviors; Serosorting