Risk Behavior for Gay Men: EXPLORE Project

Abstract

The Risk Behavior for Gay Men questionnaires were a core component of the large-scale, nationwide HIV prevention behavioral trial known as the EXPLORE Project. This study involved approximately 4,300 men who have sex with men (MSM) recruited across six major U.S. cities (Boston, Chicago, Denver, New York, San Francisco, and Seattle). The primary objective of the EXPLORE trial, and thus the associated risk behavior scales, was to rigorously evaluate the effectiveness and efficacy of an intensified behavioral counseling program designed to reduce high-risk sexual behaviors and prevent the acquisition of the Human Immunodeficiency Virus (HIV) among this vulnerable population. The instruments were administered longitudinally across multiple assessment points to track changes in behavior over time.

Keywords

HIV prevention, Risk Behavior, Men Who Have Sex with Men (MSM), EXPLORE Study, Behavioral Intervention, Counseling, Sexual Health, HIV acquisition, CAPS.

Authors

Centre for AIDS Prevention Studies (CAPS), led by primary investigators including BA Koblin, MA Chesney, and MJ Husnik.

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Purpose

The primary purpose of the Risk Behavior for Gay Men instruments was to serve as the key outcome measure for the EXPLORE behavioral intervention trial. Specifically, the tools were developed to measure the efficacy of the intensive behavioral counseling program in reducing the incidence of unprotected anal intercourse (UAI) and other high-risk sexual practices over time among participants.

These questionnaires tracked changes in sexual behavior longitudinally, allowing researchers to determine if the intervention group demonstrated statistically significant reductions in high-risk activities compared to the control group, thereby measuring the tool’s utility in preventing the acquisition of HIV.

Construct

The scale primarily measures the construct of Sexual Risk Behavior specific to the MSM population. This construct is operationalized through various dimensions of sexual practice and behavior, including frequency of sexual acts, partner types (main versus casual), and consistent use of barrier methods such as condoms. The instruments aim to quantify the level of engagement in behaviors that increase the likelihood of sexually transmitted infections, particularly HIV.

The instruments were designed to capture detailed information regarding the context of sexual encounters—including the influence of substance use and partnership dynamics—which are critical mediating factors in understanding and predicting HIV prevention efforts. The overall score derived from these measures reflects the participant’s level of risk exposure.

Validity

While specific detailed validity scores (e.g., convergent, discriminant) are typically housed within the primary reference paper (Koblin et al., 2003), the overall validity of the scales is derived from their rigorous development and use in one of the largest behavioral clinical trial designs targeting MSM risk reduction.

Content validity is ensured by the scales being developed by experts at CAPS, focusing on known behavioral risk factors for HIV acquisition, such as unprotected anal intercourse with partners of unknown or discordant HIV status. Criterion validity is established by demonstrating that scores on the risk behavior measures correlate logically with subsequent HIV seroconversion rates observed during the trial period.

Reliability

Reliability of the instruments, particularly concerning internal consistency (e.g., Cronbach’s alpha) and test-retest reliability over short periods, is essential for measuring behavioral change accurately within the context of an intervention trial. Although specific coefficients are not detailed in the summary source, high reliability is inferred given the scale’s deployment in a major, federally funded clinical trial which necessitates robust psychometric properties.

The longitudinal nature of the EXPLORE study, which utilized three distinct assessment questionnaires over a multi-year period, confirms the instruments’ utility in providing consistent and reliable measures of behavioral change necessary to assess the success of the behavioral intervention.

Factor Analysis

Specific factor analysis details are located within the technical documentation and the primary peer-reviewed reference (Koblin et al., 2003). Given the multi-faceted nature of sexual risk behavior, it is likely that the scale items load onto several distinct factors, such as: (1) high-risk sexual activity with casual partners; (2) high-risk sexual activity within primary relationships; and (3) factors related to substance use during sexual encounters. These underlying factors help isolate specific areas where the intervention achieved the greatest impact on risk reduction.

Instrument

Test Type: Self-report questionnaire / Behavioral Assessment Tool

Format: Multiple questionnaire versions administered longitudinally (Baseline, 6-12 month, 18-24 month assessment).

Language Available: Primarily English (used in US cities).

Population Group: Men who have sex with men (MSM).

Age Group: Adult men (specific range typically 18+).

Population Details: Approximately 4,300 MSM recruited from six major US metropolitan areas, participating in a randomized controlled cohort study.

Test Methodology: Structured interview or self-administered questionnaire format, designed for repeated measurement in a clinical trial setting to track changes in risk behaviors.

Keywords

MSM, Sexual Risk, Unprotected Anal Intercourse (UAI), Longitudinal Study, Public Health, Seroconversion, CAPS, Randomized Controlled Trial.

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Authors

Author ORCID Identifier: N/A (Information not provided in source.)

Affiliation Email addresses: N/A (Information not provided in source.)

Correspondence Address: Centre for AIDS Prevention Studies (CAPS), University of California San Francisco (UCSF).

Permissions & Fee and Test Year

The scale was developed by the Centre for AIDS Prevention Studies (CAPS) for use within the federally funded EXPLORE trial, which commenced recruitment in the late 1990s and published baseline data in 2003. Use of the instrument for academic research typically requires direct permission from CAPS, though the materials are often made available for non-commercial research purposes.

Test Year: Baseline data published in 2003 (with the study running from approximately 1999 to 2003/2004).

Reference’s

BA Koblin, MA Chesney, MJ Husnik, et al. High-Risk Behaviors among Men Who Have Sex with Men in 6 US Cities: Baseline Data from the EXPLORE Study. American Journal of Public Health. 2003 93: 926–932.

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Items of the Risk Behavior for Gay Men: EXPLORE Project

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The four versions of the instrument used during the EXPLORE study were titled:

• Risky Behaviour for Gay Men (baseline)
• Risky Behaviour for Gay Men (6-12 month assessment)
• Risky Behaviour for Gay Men (18-24 month assessment)
• Feedback survey

The original PDF assessment tools related to the EXPLORE Project are available for download here:

• The original PDF for the screening and baseline assessment: Explore_RiskAssessment_screen
• The original PDF for the 6-12 month assessment: Explore_RiskAssessment_6to12
• The original PDF for the 18-24 month assessment: Explore_RiskAssessment_18to48
• The original PDF for the general feedback survey: ExploreFeedbackSurvey.gen