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New Measures for Research on Men Who Have Sex with Men and for At-Risk Heterosexuals: Tools to Study Links Between Structural Interventions or Large-Scale Social Change and HIV Risk Behaviors, Service Use, and Infection

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Abstract

Large-scale structural interventions and “Big Events” like revolutions, wars and major disasters can affect HIV transmission by changing the sizes of at-risk populations, making high-risk behaviors more or less likely, or changing contexts in which risk occurs. This paper describes new measures to investigate hypothesized pathways that could connect macro-social changes to subsequent HIV transmission. We developed a “menu” of novel scales and indexes on topics including norms about sex and drug injecting under different conditions, experiencing denial of dignity, agreement with cultural themes about what actions are needed for survival or resistance, solidarity and other issues. We interviewed 298 at-risk heterosexuals and 256 men who have sex with men in New York City about these measures and possible validators for them. Most measures showed evidence of criterion validity (absolute magnitude of Pearson’s r ≥ 0.20) and reliability (Cronbach’s alpha ≥ 0.70). These measures can be (cautiously) used to understand how macro-changes affect HIV and other risk. Many can also be used to understand risk contexts and dynamics in more normal situations. Additional efforts to improve and to replicate the validation of these measures should be conducted.

Resumen

Las intervenciones estructurales a gran escala y los “Grandes Eventos”, como revoluciones, guerras y desastres mayores, pueden afectar la transmisión de VIH al cambiar el tamaño de las poblaciones en riesgo, hacer que las conductas de alto riesgo sean más o menos probables, o cambiar los contextos en los que se produce el riesgo. Este documento describe nuevas medidas para investigar vías hipotéticas que podrían conectar cambios macro-sociales con una posterior transmisión del VIH. Desarrollamos un “menú” de escalas e índices novedosos sobre temas que incluyen normas sobre el sexo y la inyección de drogas en diferentes condiciones, experimentar negación de la dignidad, acuerdo con temas culturales sobre qué acciones son necesarias para la supervivencia o la resistencia, la solidaridad y otros temas. Entrevistamos a 298 heterosexuales en riesgo y a 256 hombres que tienen sexo con hombres en la ciudad de Nueva York sobre estas medidas y sus posibles validadores. La mayoría de las medidas mostraron evidencia de validez de criterio (magnitud absoluta de r ≥ 0.20 de Pearson) y confiabilidad (alfa de Cronbach ≥ 0.70). Estas medidas pueden usarse (con cautela) para comprender cómo los cambios macroeconómicos afectan el VIH y otros riesgos. Muchas de estas medidas también pueden usarse para comprender contextos de riesgo y dinámicas en situaciones más normales. Se deben realizar esfuerzos adicionales para mejorar y replicar la validación de estas medidas.

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Notes

  1. We use the term “at-risk heterosexuals” rather than “high-risk heterosexuals” because the risk comes from a dialectical mix of outside and personal influences and actions. There is a tendency to see the high risk of “high-risk heterosexuals” as a characteristic of the individual and thereby ignore both the sociocultural interactions that shape behaviors and practices and also the epidemiologic dynamics that affect whether their risk partners are or are not infected and infectious. Although an imperfect formulation, “at-risk heterosexual” can more easily call attention to this dialectic.

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Funding

This research was supported by NIH Grants R01DA031597, P30DA011041, and DP1DA034989. The International AIDS Society (IAS) and the National Institute on Drug Abuse supported the post-doc fellowship of GN. We also acknowledge support from the University of Buenos Aires Grants UBACyT 20020130100790BA and UBACyT 20020100101021. The views presented in this paper represent only the authors and not the funding agencies.

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Authors and Affiliations

  1. Institute for Infectious Disease Research, National Development and Research Institutes, Inc., 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA

    S. R. Friedman & P. Mateu-Gelabert

  2. Center for Drug Use and HIV Research, New York, NY, USA

    S. R. Friedman & P. Mateu-Gelabert

  3. Health and Nutrition Sciences, Brooklyn College, Brooklyn, NY, USA

    E. R. Pouget

  4. Brooklyn Legal Service’s Corp A (Group Representation Unit), Brooklyn, NY, USA

    M. Sandoval

  5. Medical School, University of Cyprus, Nicosia, Cyprus

    G. K. Nikolopoulos

  6. University of Buenos Aires and Intercambios Civil Association, Buenos Aires, Argentina

    D. Rossi

  7. Medicine, University of California San Francisco, San Francisco, CA, USA

    J. D. Auerbach

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  1. S. R. Friedman
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Correspondence to S. R. Friedman.

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Conflicts of interest

The authors (Friedman, Samuel R; Pouget, Enrique R, Sandoval, Milagros; Rossi, Diana; Mateu-Gelabert, Pedro; Nikolopoulos, Georgios K; Schneider, John A; Smyrnov, Pavlo; Stall, Ron D) all declare that they have no competing interests.

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Research Involving Human Participants and Animals

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Friedman, S.R., Pouget, E.R., Sandoval, M. et al. New Measures for Research on Men Who Have Sex with Men and for At-Risk Heterosexuals: Tools to Study Links Between Structural Interventions or Large-Scale Social Change and HIV Risk Behaviors, Service Use, and Infection. AIDS Behav 24, 257–273 (2020). https://doi.org/10.1007/s10461-019-02582-w

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