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Methods for the Design and Analysis of Relationship and Partner Effects on Sexual Health

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Abstract

Sexual intercourse involves two people and many aspects of sexual health are influenced by, if not dependent on, interpersonal processes. Yet, the majority of sexual health research involves the study of individuals. The collection and analysis of dyadic data present additional complexities compared to the study of individuals. The aim of this article was to describe methods for the study of dyadic processes related to sexual health. One-sided designs, including the PLM, involve a single individual reporting on the characteristics of multiple romantic or sexual relationships and the associations of these factors with sexual health outcomes are then estimated. This approach has been used to study how relationship factors, such as if the relationship is serious or casual, are associated with engagement in HIV risk behaviors. Such data can be collected cross-sectionally, longitudinally or through the use of diaries. Two-sided designs, including the actor–partner interdependence model, are used when data are obtained from both members of the dyad. The goal of such approaches is to disentangle intra- and inter-personal effects on outcomes (e.g., the ages of an individual and his partner may influence sexual frequency). In distinguishable datasets, there is some variable that allows the analyst to differentiate between partners within dyads, such as HIV status in a serodiscordant couple. When analyzing data from these dyads, effects can be assigned to specific types of partners. In exchangeable dyadic datasets, no variable is present that distinguishes between couple members across all dyads. Extensions of these approaches are described.

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Acknowledgments

During the preparation of this manuscript, Brian Mustanski was supported as a Principal Investigator on a grant for research on relationships and the health of YMSM from the National Institute of Mental Health (R21MH095413). He was also supported for research on LGBT Health from the William T. Grant Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health, or the William T. Grant Foundation. This article was an output of a meeting on male couples and sexual health co-organized by Drs. Jeffrey Parsons and Brian Mustanski. We thank anonymous reviewers for their helpful comments on drafts of the article.

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Appendix 1: HIV-Risk Assessment for Sexual Partnerships (H-RASP)

Appendix 1: HIV-Risk Assessment for Sexual Partnerships (H-RASP)

Directions/Prompt These next questions will be about vaginal, anal, or oral sex. Vaginal sex refers to penis in vagina; anal sex refers to penis in the anus or butt; and oral sex refers to penis in mouth, or mouth on vagina, or mouth in or around the butt. Remember your answers to these questions will be private. Please try your best to answer each question.

Entry Questions

HRASP_1. In your ENTIRE LIFE, how many females have you had oral, vaginal, or anal sex with? [numerical response]

HRASP_2. In your ENTIRE LIFE, how many males have you had oral or anal sex with? [numerical response]

IF HRASP_1 > 0: HRASP_3. You said you had oral, vaginal, or anal sex with a total of [HRASP_1] females in your ENTIRE LIFE. In the PAST 6 MONTHS, how many females have you had oral, vaginal or anal sex with? [numerical response]

If HRASP_2 > 0: HRASP_4. You said you had oral or anal sex with a total of [HRASP_2] males in your ENTIRE LIFE. In the PAST 6 MONTHS, how many males have you had oral or anal sex with? [numerical response]

Partner-By-Partner Questions

Directions/Prompt When answering the next question think about the PAST 6 MONTHS; the time period between [sixmonthsMONTH] [sixmonthsYEAR] and today.

If HRASP_3 + HRASP_4 > 0: Initials_P1. Enter the initials of the MOST recent sexual partner you had in the PAST 6 MONTHS. If you do not know this partner’s name, pick two letters that will help you remember, like ‘BP’ for ‘the guy at my Birthday Party’.

If HRASP_3 + HRASP_4 > 1: Initials_P2. Please enter the initials of the sexual partner you had before [Initials_P1], within the PAST 6 MONTHS. If you do not know this partner’s name, pick two letters that will help you remember, like ‘BP’ for ‘the guy at my Birthday Party’.

If HRASP_3 + HRASP_4 > 2: Initials_P3. Please enter the initials of the sexual partner you had before [Initials_P1] and [Initials_P2], within the PAST 6 MONTHS. If you do not know this partner’s name, pick two letters that will help you remember, like ‘BP’ for ‘the guy at my Birthday Party’.

Partner 1: PBP_1. Is [Initials_P1] male, female, or transgender?

1, Male | 2, Female | 3, MTF (Male to Female Transgender] | 4, FTM (Female to Male Transgender)

PBP_2. How did you meet [Initials_P1]?

1, You went to the same school/college/university | 2, You met through a phone app | 3, You lived in the same neighborhood | 4, This person was a friend of another friend of yours | 5, You met at a party | 6, You met at a bar | 7, You met on the internet | 8, You met in a park | 9, You met in a bathhouse | 10, You met in some other way

If PBP_2 = 10: PBP_3. Please specify how you met [Initials_P1] [literal response]

PBP_4. What was the HIV status of [Initials_P1]?

1, He/she was HIV positive | 2, He/she was HIV negative | 3, I don’t know his/her HIV status

If PBP_4 = 1 OR 2: PBP_5. How did you find out about [Initials_P1]’s HIV status?

1, He/she told me | 2, I found out through another person | 3, I assumed his/her HIV status | 4, Other

If PBP_5 = 4: PBP_6. Please specify how you found out about [Initials_P1]’s HIV status [literal response]

If PBP_4 = 1 OR 2: PBP_7. How confident are you about [Initials_P1]’s HIV status?

1, Extremely | 2, Somewhat | 3, Not really | 4, Not at all

PBP_8. How would you describe [Initials_P1]’s race or ethnic background?

1, White (non-Hispanic or Latino/a) | 2, Black/African American (not Hispanic or Latino/a) | 3, Hispanic or Latino/a | 4, Asian or Pacific Islander | 5, Native American | 6, Other | 7, Multi-racial

If PBP_8 = 6: PBP_9. You described [Initials_P1]’s race or ethnic background as Other, please specify [literal response]

If PBP_8 = 7: PBP_10. You described [Initials_P1]’s race or ethnic background as Multi-racial, please specify [literal response]

PBP_11. What was your relationship with [Initials_P1]?

1, Serious relationship (boyfriend/girlfriend), someone you dated for awhile and feel very close to | 2, Casually dating but not serious | 3, Sleeping with this person (fuck buddy or booty call) but not dating | 4, One night stand | 5, Stranger or anonymous person

If PBP_11 = 1, 2, OR 3: PBP_12. How long have you been with [Initials_P1]?

1, Less than a month | 2, 1 to 3 months | 3, 4 to 6 months | 4, 7 months to 11 months | 5, 1 to 3 years | 6, Over 3 years

PBP_13. I really wanted my relationship with [Initials_P1] to last.

1, Strongly agree | 2, Agree | 3, Disagree | 4, Strongly disagree

PBP_14. [Initials_P1] was having sex with someone else.

1, Strongly agree | 2, Agree | 3, Disagree | 4, Strongly disagree

PBP_15. I was having sex with someone else.

1, Yes | 2, No

PBP_16. How old was [Initials_P1] when you first started having sex with him/her?

1, He/she was more than 2 years younger than you | 2, He/she was about 1 year younger than you | 3, You were the same age | 4, 1 to 2 years older than you | 5, 3 to 4 years older than you | 6, 5 or more years older than you | 7, I don’t know how old he/she is

PBP_17. Has [Initials_P1] ever hit, slapped, punched, or hurt you?

1, Yes | 2, No

PBP_18. Did [Initials_P1] ever force you to have sex when you didn’t want to? (“Force” includes physical and non-physical pressure, such as pushing you, arguing with you or threatening you in order to have sex).

1, Yes | 2, No

If PBP_18 = 1: PBP_19. Did [Initials_P1] ever force you to have unprotected sex when you didn’t want to?

1, Yes | 2, No

PBP_19. Have you ever hit, slapped, punched, or hurt [Initials_P1] in a physical way?

1, Yes | 2, No

PBP_20. Did you ever force [Initials_P1] to have sex when he/she didn’t want to? (“Force” includes physical and non-physical pressure, such as pushing, arguing or threatening your partner in order to have sex).

1, Yes | 2, No

If PBP_20 = 1: PBP_21. Did you ever force [Initials_P1] to have unprotected sex when he/she didn’t want to?

1, Yes | 2, No

PBP_22. How frequently did you drink alcohol within two hours of having sex with [Initials_P1]?

1, Never | 2, Less than half the time | 3, About half the time | 4, More than half the time | 5, Always

PBP_23. How frequently did you use drugs within two hours before having sex with [name_]?

1, Never | 2, Less than half the time | 3, About half the time | 4, More than half the time | 5, Always

If PBP_1 = 2 OR 4: PBP_24. How many times did you have vaginal sex with [Initials_P1] during the PAST 6 MONTHS? [numerical response]

If PBP_24 > 0: PBP_25. How many times did you have vaginal sex without using a condom with [Initials_P1]? [numerical response]

PBP_26. How many times did you have anal sex with [Initials_P1] during the PAST 6 MONTHS? [numerical response]

If PBP_26 > 0: PBP_27. How many times did you have anal sex without using a condom with [Initials_P1]? [numerical response]

If PBP_27 > 0: PBP_28. How often did you use have sex without a condom during anal sex where you were the top with [Initials_P1]? [numerical response]

If PBP_37 > 0: PBP_29. How often did you have sex without a condom during anal sex where you were the bottom with [Initials_P1]?

PBP_30. How many times did you have oral sex with [Initials_P1] during the PAST 6 MONTHS? [numerical response]

If PBP_30 > 0: PBP_31. How many times did you use a condom during oral sex with [Initials_P1]? [numerical response]

Repeat for Partner 2 and Partner 3 as needed.

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Mustanski, B., Starks, T. & Newcomb, M.E. Methods for the Design and Analysis of Relationship and Partner Effects on Sexual Health. Arch Sex Behav 43, 21–33 (2014). https://doi.org/10.1007/s10508-013-0215-9

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