# Presentation: 674400

## 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

## 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.

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

**Approaches to Partnership Research**

## Types of Concurrent Partnerships

- 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”

-     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 Clubs

- Bars

- Parks

- On the Street

**ANONYMOUS PARTNERS**

- Bars

**CASUAL PARTNERS**

- Personal Ads

- Qualitative Study of MSM with GC in Seattle – 1996-98 (n=19)

- AN ETHNOGRAPHIC STUDY OF SEXUAL PRACTICES AND PARTNERING CHARACTERISTICS OF MSM WITH GONORRHEA (GC) IN SEATTLE
- _Galea JT_1, 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

**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)
- 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

## 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

## UAI by Partner Characteristic (n=109): Partner Type or Partner Characteristics

|  | Unprotected Anal Sex
(n=69)
% (n) | No Unprotected Anal Sex
(n=40)
% (n) | P-value |
| --- | --- | --- | --- |
| Partner Age | 35.1 | 32.3 | 0.062 |
| Partner Ethnicity: White v. Other | 66.7 (46) | 67.5 (27) | 0.929 |
| Partner Type: Main v. Other* | 47.8 (33) | 27.5 (11) | 0.037 |
| Partner Sero-Status:
    Negative
    Positive
    Unknown | 
43.5 (30)
17.4 (12)
39.1 (27) | 
40.0 (16)
15.0 (6)
45.0 (18) | 
0.830 |
| Drug Use Last Sexual Contact    | 47.8 (33) | 35.0 (14) | 0.193 |

**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.
- Significantly more unprotected anal intercourse (UAI) is reported with a main partner than with other partners.
- And....majority 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.
- 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.

## 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

## Mean PAS Score By Partnership Type: Last 3 Partners MSM Recently Infected w/HIV

| Partner Type | Total |
| --- | --- |
| Main | 21.2 |
| Friend | 15.8 |
| Regular | 12.12 |
| Acquaintance | 9.1 |
| Onetime | 6.2 |
| Unknown | 2.3 |
| Trade | 1.3 |

**(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:    20-27
            28-35
            36-41
            42-64 | 12.6
10.0
8.7
9.9 | 0.106 |
| Education: High School or Less
                  Some College
                  Completed College
                  Post Graduate | 12.8*
11.8
8.6
7.9* | 0.007 |
| Number of Male Partners Last 12 Months:  < 10
                                                                     10-25
                                                                      > 25 | 12.1*
9.9
8.6* | 0.022 |
| Ever Had Group Sex: Yes
                                    No | 9.7
15.6 | 0.001 |
| Ever Bought Sex:       Yes
                                    No | 8.0
11.1 | 0.014 |
| Ever Used the Internet to Find Sex Partners: Yes
                                                                        No | 9.2
12.8 | 0.003 |

## 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