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Transmission of STIs/HIV at the Partnership Level: Developing New Measures

Transmission of STIs/HIV at the Partnership Level: Developing New Measures. Pamina M. Gorbach, DrPH 1 & Lydia Drumright, MPH 2 1 Department of Epidemiology, UCLA 2 Department of Epidemiology,UCSD/SDSU. Approaches to Partnership Research.

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Transmission of STIs/HIV at the Partnership Level: Developing New Measures

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  1. Transmission of STIs/HIV at the Partnership Level:Developing New Measures Pamina M. Gorbach, DrPH1 & Lydia Drumright, MPH2 1Department of Epidemiology, UCLA 2Department of Epidemiology,UCSD/SDSU

  2. Approaches to Partnership Research Measures of sexual partnerships traditionally use narrow descriptions such as “main”, “other” or “casual” partner. Not clear what these mean to respondents. • Qualitative: describe types of partnerships • Quantitative: -Distribution of risky partnerships. Who (demographics) has risky partnership and how often; potential for epidemic spread.

  3. Types of Concurrent Partnerships Primary Partner No Primary Partner Reciprocal Reactive Separational Transitional Compensatory Experimental Group sex “Bootycall” “Fuckbuddy” Survival Sex= (Sex for $ & drugs) “1 Night Stands”= “Flings” Co-parent= “Baby’s Mom/Dad” Gorbach PM, Stoner BP, Aral SO, Coronado N, Connor S, Holmes KK. It Takes a Village: Understanding Concurrent Partnerships In Seattle, WA. Sex Transm Dis, 2002; 29(8).

  4. Qualitative Study of MSM with GC in Seattle – 1996-98 (n=19) CASUAL PARTNERS ANONYMOUS PARTNERS Phone & Computer Chat rooms Sex Clubs Bars Parks On the Street Personal Ads Bars AN ETHNOGRAPHIC STUDY OF SEXUAL PRACTICES AND PARTNERING CHARACTERISTICS OF MSM WITH GONORRHEA (GC) IN SEATTLE Galea JT1, Gorbach PM1, Whittington WL1, Celum CL1. 1University of Washington, Seattle WA, U.S.A.. ISSTDR – poster – 1999, Denver CO.

  5. Measures of Types of Concurrent P-Ships Reciprocal: My partner and I agreed that it was OK for us to have sex with other people, or not be exclusive. Fuckbuddy: The other person I had sex with was a friend or someone that I knew socially. One-night stand:I had a one-time fling. Transitional:I was still with my partner, but I felt like it was ending, so I started having sex with someone else Compensatory: I wanted to continue with my partner, but something was missing in our relationship so I started seeing someone else as well. Experimental : At that time in my life I wanted to explore with different sexual partners and I didn’t want to be committed to one person. Group sex:It was group sex - my partner was involved too. Reactive:I thought my partner had sex with someone else, so I had sex with someone else too. Seperational: My partner was away so I had sex with someone else. Recreational sex: I was partying and using alcohol or drugs and it just happened. Ex: I had sex with an ex, or someone I used to involved with.

  6. Partnership Types: MSM UNKNOWN PERSON- someone that you had never met before you had sexual contact and never plan to see again ONETIME PARTNER- someone you knew of or had seen before, but you had sexual contact with only one time ACQUAINTANCE- someone you have had sexual contact with more than once, but not on a regular basis, and who you don't socialize with FRIEND- someone you have had sexual contact with more than once, but not on a regular basis, and you normally socialize with REGULAR PARTNER- someone who you have sex with on a regular basis MAIN PARTNER- someone who is your primary sexual partner TRADE PARTNER- someone who you gave sex to for money or other goods or someone who gave you sex for money or other goods

  7. Distribution of Types of Partnerships • Computer Assisted Self-Interview of individuals recently infected with HIV – Southern California Primary Infection Program (funded by AIEDRP) • Over 100 men who have sex with men interviewed • Asked about last 3 partners, all partners in past month, past 3 months, and past year

  8. Percentage of Types of Partners of Last Three Sexual Partners: AIEDRP (n=324 partners from 109 men)

  9. Partner Types by Time: MSM w/ Primary HIV (n=109)

  10. HIV Sero-status of Last Partner

  11. UAI by Partner Characteristic (n=109): Partner Type or Partner Characteristics * OR of 2.6 (ci: 1.1, 6.4) for main partner in multivariate analysis

  12. Conclusions: p-ships of AIEDRP • Sexual activity is reported with a range of partner types: most of most recent sexual activity with a main partner but many had anonymous, one-time, or acquaintance partners. • Significantly more unprotected anal intercourse (UAI) is reported with a main partner than with other partners. • And….majority of main partners are HIV negative.

  13. Quantifying Partnership Types

  14. Partnership Assessment Scale: (PAS) • Collect theoretically important measures of the emotional, social and physical relationship between partners through CASI questionnaires. • Using factor analysis identify variables that hold together as a construct of emotional, social or physical functioning. • Sum responses to the salient variables to create a partnership assessment score. • Analyze the score for predictive value of partnership risk and type using ANCOVA and logistic regression.

  15. MSM PAS – 23 measures Circle each of the following types of information you know about your boyfriend or main partner. 1.       First name 2.       Last name 3.       Telephone number 4.       email address 5.       Home Address 6.       Name of work place Which of the following activities have you done with your boyfriend or main partner? 1.       Talked on the telephone or by email 2.       Been together in a group with other friends 3.       Shared a meal 4.       Been to his house or he has been to your house 5.       Slept in the same bed for an entire night 6.       Gone away together (on vacation or business trip) 7.       Lent him money or borrowed money from him 8.       Lived in the same house together 9.       Had coffee together 10.   Talked about each of your careers, or career goals 11.   Talked about problems you each may have with your friends 12.   Talked about problems you each may have with your families 13.   Talked about each of your health problems 14.   Talked about each of your past lovers or partners 15.   Talked about using condoms with each other 16.   Met your boyfriend’s family 17.   Introduced your boyfriend to your family

  16. Mean PAS Score By Partnership Type: Last 3 Partners MSM Recently Infected w/HIV (n=109)

  17. Differences in PAS by Partnership Type: Among Last 3 Partners The PAS score was significantly lower than the main partner PAS for all partnership types except partner 1 friend.

  18. Cronbach’s Alpha for PAS:Last 3 Partners, Overall and Partnership Type Values * *:cutoff line for acceptable reliability (0.7)

  19. Mean Values of Mean PAS Scores for Last 3 Partners By Predicting Factors

  20. Why is the Partnership Level Relevant? • There is great variation in types of partnerships • Condom use and other risk behaviors including UAI vary within an individual by the partnership: • Dynamics • Type of Partnership • To reduce disease transmission, counseling of STI & HIV patients needs to be tailored to their type(s) of partnership

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