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

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 Qualitative: describe types of partnerships Quantitative: Quantitative: -Distribution of risky partnerships. Who (demographics) has risky partnership and how often; potential for epidemic spread. Approaches to Partnership Research

Primary Partner No Primary Partner “Fuckbuddy” Survival Sex= (Sex for $ & drugs) “1 Night Stands”= “Flings” Co-parent= “Baby’s Mom/Dad” Reciprocal Reactive Separational Transitional Compensatory Experimental Group sex “Bootycall” Types of Concurrent Partnerships 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).

Phone & Computer Chat rooms Sex ClubsBars ParksOn the Street ANONYMOUS PARTNERS Bars CASUAL PARTNERS Personal Ads Qualitative Study of MSM with GC in Seattle – (n=19) 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.

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.

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

Distribution of Types of Partnerships Computer Assisted Self-Interview of individuals recently infected with HIV – Southern California Primary Infection Program (funded by AIEDRP) 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 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 Asked about last 3 partners, all partners in past month, past 3 months, and past year

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

Partner Types by Time: MSM w/ Primary HIV (n=109) Partner Type # Past Month % (n) # 12 Months % (n) Unknown 42.2 (46) 85.3 (93) Onetime 29.4 (32) 61.5 (67) Acquaintance 31.2 (34) 64.2 (70) Friend 17.4 (19) 45.0 (49) Regular 19.3 (21) 41.3 (45) Main 36.7 (40) 50.5 (55) Trade 5.5 (6) 15.6 (17)

HIV Sero-status of Last Partner

Unprotected Anal Sex (n=69) % (n) No Unprotected Anal Sex (n=40) % (n) P- value Partner Age Partner Ethnicity: White v. Other 66.7 (46) 67.5 (27) Partner Type: Main v. Other* 47.8 (33)27.5 (11)0.037 Partner Sero-Status: Negative Negative Positive Positive Unknown Unknown 43.5 (30) 17.4 (12) 39.1 (27) 40.0 (16) 15.0 (6) 45.0 (18) Drug Use Last Sexual Contact 47.8 (33) 35.0 (14) 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

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. 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. Significantly more unprotected anal intercourse (UAI) is reported with a main partner than with other partners. And….m ajority of main partners are HIV negative. And….m ajority of main partners are HIV negative.

Quantifying Partnership Types

Partnership Assessment Scale: (PAS) Collect theoretically important measures of the emotional, social and physical relationship between partners through CASI questionnaires. 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. 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. 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. Analyze the score for predictive value of partnership risk and type using ANCOVA and logistic regression.

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. 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 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

Mean PAS Score By Partnership Type: Last 3 Partners MSM Recently Infected w/HIV Partner Type Total Main21.2 Friend15.8 Regular12.12 Acquaintance9.1 Onetime6.2 Unknown2.3 Trade1.3 (n=109)

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.

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

Mean Values of Mean PAS Scores for Last 3 Partners By Predicting Factors Mean PAS p Age: Education: High School or Less Some College Some College Completed College Completed College Post Graduate Post Graduate12.8* * Number of Male Partners Last 12 Months: < > 25 > *9.98.6* Ever Had Group Sex: Yes No No Ever Bought Sex: Yes No No Ever Used the Internet to Find Sex Partners: Yes No No

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