Abstract
BackgroundLittle research has assessed the degree of severity and ordering of different types of sexual behaviors for HIV/STI infection in a measurement scale. The purpose of this study was to apply the Rasch model on psychometric assessment of an HIV/STI sexual risk scale among men who have sex with men (MSM).MethodsA cross-sectional study using respondent driven sampling was conducted among 351 MSM in Shenzhen, China. The Rasch model was used to examine the psychometric properties of an HIV/STI sexual risk scale including nine types of sexual behaviors.ResultsThe Rasch analysis of the nine items met the unidimensionality and local independence assumption. Although the person reliability was low at 0.35, the item reliability was high at 0.99. The fit statistics provided acceptable infit and outfit values. Item difficulty invariance analysis showed that the item estimates of the risk behavior items were invariant (within error).ConclusionsThe findings suggest that the Rasch model can be utilized for measuring the level of sexual risk for HIV/STI infection as a single latent construct and for establishing the relative degree of severity of each type of sexual behavior in HIV/STI transmission and acquisition among MSM. The measurement scale provides a useful measurement tool to inform, design and evaluate behavioral interventions for HIV/STI infection among MSM.
Highlights
Little research has assessed the degree of severity and ordering of different types of sexual behaviors for HIV/STI infection in a measurement scale
All items that indicate different types of sexual behaviors contribute to the total score, and no consideration is given to the degree of severity of an item that reflects a particular type of sexual behavior
There were 92 (26%) men who have sex with men (MSM) who had ever engaged in commercial sex in the past six months, including 58 (17%) selling sex to MSM, 34 (10%) buying sex from Money boys (MBs), and 19 (5%) buying sex from female sex workers
Summary
Little research has assessed the degree of severity and ordering of different types of sexual behaviors for HIV/STI infection in a measurement scale. Subjects are asked how often they used condoms when practicing anal sex with MSM in the last three months, or used condoms when practicing oral sex with male sex workers in the last three months While this method is implemented, it lacks sensitivity in measuring sexual risk since a single measure can only cover a limited domain of sexual risk for HIV/STI infection [2]. Having unprotected anal sex with male sex workers would contribute 1 point to the total score, the same as having unprotected oral sex with regular sex partners The former behavior is likely to represent a far greater level of sexual risk for HIV/STI infection than the latter, yet this would not be reflected in the total score. The difference between scores of two to four may not be the same as the same difference between scores of five to seven, in terms of the degree of severity of sexual risk for HIV/STI infection
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