Although numerous studies have examined sexual and substance use behaviors that put people at risk for sexually transmitted infections including HIV, most focus on an overall measure of aggregate risk or a few simple and particular subtypes of sexual acts assessed in separate analyses. In this article, we introduce a more sensitive approach to assess how the relative characteristics of sex acts may determine the level of risk in which an individual chooses to engage. Project AWARE, a randomized clinical trial conducted among 5012 patients in nine STD clinics across the U.S., is used to illustrate the approach. Our study was guided by two aims: (1) describe a new approach to examine the count of sexual acts using a disaggregated repeated measures design and (2) show how this new approach can be used to evaluate interactions among different categories of sexual risk behaviors and other predictors of interest (such as gender/sexual orientation). Profiles of different subtypes of sexual acts in the past 6 months were assessed. Potential interactions of the characteristics associated with each subtype which resulted in up to 48 distinct subtypes of sexual risk behaviors—sex with a primary/non-primary partner; partner’s HIV status; vaginal/anal sex; condom use; and substance use before or during sex act—can be examined. Specifically, we chose condom use and primary and non-primary status of partner as an application in this paper to illustrate our method. There were significantly more condomless sex acts (M = 23, SE = 0.9) and sex acts with primary partners (M = 27.1, SE = 0.9) compared to sex acts with condoms (M = 10.9, SE = 0.4, IRR = 2.10, 95% CI 1.91–2.32, p < .001) and sex acts with non-primary partner (M = 10.9, SE = 0.5, IRR = 2.5, 95% CI 2.33–2.78, p < .001). In addition, there were significant differences for the count of sexual risk behaviors among women who have sex with men (WSM), men who have sex with women (MSW) and men who have sex with men (MSM) for sex acts with and without condom use, primary and non-primary partner, and their interaction (ps = .03, < .0001, and .001, respectively). This approach extends our understanding of how people make choices among sexual behaviors and may be useful in future research on disaggregated characteristics of sex acts.
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This work was supported by the Office of the Director, National Institutes of Health (OD) (RC2DA028973), the National Institute on Drug Abuse (R21DA038641 and R01DA027379), and the Patient-Centered Outcomes Research (ME-1403-12907). The infrastructure of the National Drug Abuse Treatment Clinical Trials Network was used as a platform in conducting the Project AWARE trial (U10DA13720). Support from the University of Miami Center for AIDS Research (CFAR) is also acknowledged (P30 AI073961). The NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Pan, Y., Metsch, L.R., Gooden, L.K. et al. The Disaggregated Repeated Measures Design: A Novel Approach to Assess Sexual Risk Behaviors. Arch Sex Behav 50, 311–322 (2021). https://doi.org/10.1007/s10508-019-01582-0
- Sexual risk behaviors
- Repeated measures
- Generalized estimating equations
- Negative binomial regression