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A Study of the Validity of a Modified Ordinal Scale of HIV Transmission Risk Among Seropositive Men Who Have Sex with Men

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A Study of the Validity of a Modified Ordinal Scale of HIV Transmission Risk Among Seropositive Men Who Have Sex with Men A Study of the Validity of a Modified Ordinal Scale of HIV Transmission Risk Among Seropositive Men who Have Sex with Men DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Sandra J. Reed, M.B.A. Graduate Program in Education The Ohio State University 2012 Dissertation Committee: Ann A. O’Connell, Ed.D., Advisor Julianne M. Serovich, Ph.D. Dorinda J. Gallant, Ph.D. Copyright by Sandra J. Reed 2012 ABSTRACT The use of a measure of HIV transmission risk which incorporates seroadaptive behaviors is needed in order to assess the complex effects of disclosure on HIV transmission. The purpose of this study was to explore the use of a modified version of the ordinal scale of HIV risk behavior proposed by Osmond, Pollack, Paul, and Catania (2007) to operationalize the risk of HIV transmission among HIV-positive MSM and to establish the strength of the empirical evidence supporting the use of these scores for inference about HIV transmission. The original measure was modified to include the full potential for seropositioning (i.e., with and without 100% condom use) as a potential preventive strategy used by MSM to reduce the risk of HIV transmission. Additionally, the measure was applied to individual sexual encounters rather than globally so that the frequency of risk behaviors can be accurately modeled. The appropriateness of these methods was explored using data from a study involving the disclosure of serostatus to sexual partners in a sample of HIV-positive MSM. Results of the study are promising for the refinement of measurements of HIV transmission risk, and for the understanding of seroadaptive behavior in MSM. For researchers who are seeking to demonstrate the effectiveness of interventions designed to reduce HIV transmission risk, the ordinal measure provides a means for detecting qualitative shifts in sexual activity which can be critical to the question of effectiveness. ii DEDICATION For Jack & Soots … “For there we loved, and where we love is home, home that our feet may leave, but not our hearts…” --Oliver Wendell Holmes (1871) iii ACKNOWLEDGEMENTS “And he that strives to touch the stars, Oft stumbles at a straw.” -Edmund Spenser There are few times and places in history where a life such as mine would be possible. I am grateful to those who have gone before and made my journey possible. I would like to honor the fierce women of The Ohio State University who have mentored, guided, and at times cajoled me as was appropriate. First among them is my advisor Dr. Ann A. O’Connell. I thank you for sharing with me some small portion of your intellectual world. You extended a hand to me and, in so doing, changed everything. Second is Dr. Julianne M. Serovich. I thank you for opening all the doors and for teaching me how the big dogs roll. Third is Dr. Karen Zuga. I thank you for personifying the beauty, honor, and value of scholarly work. Fourth is Julie Carpenter- Hubin. I thank you for showing me how grown-ups use data. Fifth is Dr. Dorinda J. Gallant. I thank you for sharing your passion, energy, and joy in learning and teaching. Finally, I would like to recognize Deb Zabloudil, an extraordinary woman, mentor, sister, and friend who has shown so many of us the way. I also offer thanks to the men of Technology Education who welcomed me into the fold. First is Peter Lund. You are the quintessential teacher and advocate. Thank you for showing me what it means to stand for something - steadfast, unwavering, and iv with love. Second is Dr. David Meyer, a mensch who paved the way for us all. My admiration and respect for you glows undiminished. Third is Dr. Mark Mahoney, a young man of remarkable passion and imagination, with an equally remarkable heart. It makes me smile to think of each of you, and I will always remember you. As to some very special friends, thanks must be offered to Dr. Xueli Wang, my adopted mother from Harbin. You are my wise and funny friend who literally plucked me from the street and set me right. Few would have tried, and fewer could have succeeded. You seriously impress me. Thanks also to my dissertation partner Dr. Katye Miller. Together we did battle and emerged victorious. I can’t wait to see how it all turns out. To Sally Jackson – a true friend and woman of letters. Thank you for fumbling along with me through the messy business of living in this world. You bring joy to argument and vigor to reflection. Having plumbed the depths of your vast stores of wisdom, advice, and humor across myriad topics, I consider you to be my most accomplished and learned of friends. To my family – Jack & Soots, Jay, Sue, Janie, and Nick. Despite our years of deep acquaintance, you continue to teach and inspire me. I count myself among the luckiest of all beings - for I am able to call you mi familia. As I embark on yet another journey, I am grateful in the knowledge that all paths will lead me home to you. Finally, to my son Billy J Allen Reed. To know you is my greatest pleasure, and to be counted among your friends is my greatest achievement. Thank you for your love, support, and understanding despite my weaknesses and imperfections. You make it possible for me to carry on. v VITA 1977……………..…………………………Sylvania Northview High School 1996................................................................B.A. Business, University of Toledo 2001................................................................M.B.A., University of Findlay 2007 to present ..............................................Senior Research Associate, Department of Human Development and Family Science, The Ohio State University Publications O’Connell, A. A. & Reed, S. J. (in press). Hierarchical data structures, institutional research, and multilevel modeling. In New Directions in Institutional Research – Multilevel Modeling: Techniques and Applications in Institutional Research, J. Lott & J. Antony (Eds.). Jossey-Bass. Serovich, J. M., Craft, S. M., & Reed, S. (2012). Women’s HIV disclosure to immediate family and friends. AIDS Patient Care and STDs, 26(4), 241-249. vi Serovich, J. M., Reed, S. J., Grafsky, E. L., Hartwell, E. E., & Andrist, D. W. (2011). An intervention to assist men who have sex with men disclose their serostatus to family members: Results from a pilot study. AIDS and Behavior, 15(8), 1647- 1653. Serovich, J. M., Grafsky, E. L., & Reed, S. (2010). Comparing regret of disclosing HIV versus sexual orientation information by MSM. AIDS Care, 22(9), 1052-1059. Serovich, J. M., Reed, S., Grafsky, E., & Andrist, D. (2009). An intervention to assist men who have sex with other men disclose their serostatus to casual sex partners: Results from a pilot study. AIDS Education and Prevention, 21(3), 207-219. Fields of Study Major Field: Educational Policy and Leadership Quantitative Research, Evaluation and Measurement vii TABLE OF CONTENTS ABSTRACT ........................................................................................................................ ii ACKNOWLEDGEMENTS ............................................................................................... iv VITA .................................................................................................................................. vi LIST OF TABLES ............................................................................................................ xii LIST OF FIGURES .......................................................................................................... xv Background of the Study ................................................................................................. 1 Purpose of the Study ....................................................................................................... 8 Significance of the Study .............................................................................................. 10 Potential Implications of the Study ............................................................................... 11 Limitations to Generalizability...................................................................................... 11 Limitations to Theory .................................................................................................... 12 CHAPTER 2: REVIEW OF THE LITERATURE ........................................................... 13 History of HIV and HIV Prevention in the United States ............................................. 14 HIV in Men Who Have Sex with Men (MSM) ............................................................. 18 Risk Reduction in MSM ................................................................................................ 20 viii The Importance of Serostatus Disclosure...................................................................... 22 The Need for Valid Measures of Sexual Risk Behavior ............................................... 26 The Current Measurement and Analysis of Sexual Risk Behavior ............................... 35 Validity .......................................................................................................................... 47 Current APA Standards ................................................................................................. 61 Summary ....................................................................................................................... 61 Conclusion ....................................................................................................................
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