Sexual Health Knowledge Questionnaire for HIV+ MSM

Abstract

The Sexual Health Knowledge Questionnaire (SHKQ) for HIV+ men who have sex with men (MSM) is an 18-item, self-report measure designed to assess prevention-related knowledge critical for sexual risk reduction in this specific population. Developed by Vanable and colleagues, the SHKQ focuses on practical health risks associated with sexual behavior rather than general medical aspects of HIV. Key knowledge domains evaluated include the effects of sexually transmitted disease (STD) co-infections on HIV infectivity and disease progression, the relationship between HIV viral load and transmission risk, risks associated with unprotected sex between two HIV+ partners, and differential transmission risks based on sexual role (insertive versus receptive partner during anal sex). The scale was primarily used to evaluate the effectiveness of targeted sexual risk reduction interventions.

Keywords

Sexual Health Knowledge Questionnaire (SHKQ), HIV+ MSM, Sexual Risk Reduction, Prevention Knowledge, STD Co-infections, Viral Load, Psychometrics, Health Behavior.

Authors

Peter A. Vanable, Jennifer L. Brown, Michael P. Carey, Rebecca A. Bostwick (Syracuse University).

Purpose

The primary purpose of the Sexual Health Knowledge Questionnaire (SHKQ) is to provide a reliable and valid measure specifically tailored to assess prevention-related knowledge among individuals living with HIV, particularly men who have sex with men (MSM). Existing measures of HIV/STD knowledge often target primary prevention contexts (HIV-negative populations); however, the SHKQ addresses the unique and specific knowledge gaps pertinent to secondary prevention and risk reduction among HIV+ individuals.

The instrument was developed as an integral component of a broader research program designed to evaluate a sexual risk reduction intervention for HIV+ MSM. By measuring knowledge domains corresponding to core modules within the intervention curriculum, the SHKQ serves to assess the efficacy of these programs in motivating positive behavior change and promoting public health priorities related to sexual health among this population.

Construct

The SHKQ measures Sexual Health Knowledge specifically focused on reducing sexual risk behavior in HIV+ individuals. Unlike measures assessing general medical knowledge about HIV, the SHKQ centers on the behavioral implications and transmission risks unique to persons living with the virus.

The core knowledge domains assessed by the 18 items include:

• The influence of STD co-infections on HIV infectivity and the rate of disease progression.
• The relationship between antiretroviral treatment success (resulting in an undetectable viral load) and transmission risk.
• Risks associated with serosorting (unprotected sex between two HIV+ partners), specifically concerning the transmission of drug-resistant strains or other STDs.
• Differential HIV transmission risks linked to specific sexual acts (e.g., receptive vs. insertive anal sex, oral sex).

Validity

Evidence for the validity of the SHKQ was established through measures of convergent validity and sensitivity to change. Convergent validity analyses demonstrated that SHKQ scores were positively correlated with other relevant psychological constructs and demographic variables.

• SHKQ scores showed a positive correlation with higher levels of general medical knowledge related to HIV (r = .34, p < .005).
• SHKQ scores were positively associated with having more favorable attitudes toward condom use (r = .24, p < .05), a critical component of sexual risk behavior models.
• A positive correlation was also observed between SHKQ scores and participants’ educational attainment (r = .23, p < .05).

The measure also demonstrated sensitivity to change following an intervention. Participants in the immediate intervention condition showed significant improvement in knowledge scores from baseline (M = 9.3, SD = 3.3) to follow-up (M = 10.7, SD = 2.4). Similarly, participants in the delayed intervention condition showed marked improvement after receiving the intervention (M = 10.1 before vs. M = 12.0 after; t(23) = −4.8, p < .001). These findings confirm that the SHKQ is sensitive to changes in sexual health knowledge resulting from targeted psychoeducational programs.

Reliability

The reliability of the SHKQ was assessed using test-retest reliability among a subsample of participants (N = 35) in the delayed intervention control condition. These individuals completed the questionnaire at baseline and again at a 3-month follow-up period before receiving the intervention.

The resulting test-retest reliability coefficient for the SHKQ was reported as .78 (p < .001). Based on established psychometric benchmarks (Cicchetti, 1994), this coefficient provides robust evidence of moderate to excellent stability and agreement over the 3-month period, suggesting the measure yields consistent results when administered across time in the absence of an intervening educational factor.

Factor Analysis

Information regarding the factor structure or exploratory/confirmatory factor analysis of the Sexual Health Knowledge Questionnaire (SHKQ) was not provided in the original supporting documentation for this scale entry. The measure is currently presented as a unidimensional sum score reflecting overall sexual health knowledge pertinent to risk reduction among HIV+ MSM.

Instrument

Test Type: Knowledge Questionnaire / Psychometric Scale

Format: 18 True/False items with a “Don’t Know” option.

Language Available: English (as reported in the source study).

Population Group: Clinical and community samples of persons living with HIV.

Age Group: Adults (Participants ranged from 22 to 62 years of age).

Population Details: HIV+ Men who have Sex with Men (MSM). The pilot sample (N=80) included 26% African American and 63% White participants recruited from an infectious disease clinic in upstate New York. Average age was 40.6 years (SD = 8.0).

Test Methodology: Self-report questionnaire. Scoring involves assigning a value of 1 for a correct answer and 0 for an incorrect response or “Don’t Know” selection. The total score is the sum of correct responses, where higher scores indicate greater sexual health knowledge. The scale takes approximately 5 minutes to complete.

Keywords

HIV Prevention, Sexual Health, MSM, Viral Load, STD, Knowledge Assessment, Test-Retest Reliability, Convergent Validity, Syracuse University.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Peter A. Vanable)

Correspondence Address: Peter A. Vanable, Department of Psychology & Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244.

Permissions & Fee and Test Year

The development of the SHKQ was supported by NIMH Grants R21-MH65865 and F31MH081751. The psychometric properties described in the source report are derived from research published around 2008–2009. Specific information regarding current licensing fees or explicit permissions for use outside of research contexts is not detailed in the provided content. Researchers should contact the corresponding author, Peter A. Vanable, for permissions.

Reference’s

• Carey, M. P., & Schroder, K. E. (2002). Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Education and Prevention, 14, 172–182.
• Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6, 284–90.
• Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111, 455–474.
• Johnson, B. T., Carey, M. P., Marsh, K. L., Levin, K. D., & Scott-Sheldon, L. A. (2003). Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985–2000: A research synthesis. Archives of Pediatric and Adolescent Medicine, 157, 381–388.
• Sacco, W. P., Levine, B., Reed, D. L., & Thompson, K. (1991). Attitudes about condom use as an AIDS-relevant behavior: Their factor structure and relation to condom use. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 265–272.
• Vanable, P. A., & Carey, M. P. (2006). Behavioral medicine interventions in HIV/AIDS: Challenges and opportunities for promoting health and adaptation. In A. R. Kuczmierczyk & A. Nikcevic (Eds.), A clinician’s guide to behavioral medicine: A case formulation approach. New York: Brunner-Routledge.
• Vanable, P. A., Carey, M. P., Brown, J. L., Bostwick, R., & Blair, D. (2008, March). A pilot intervention trial to promote sexual health and stress management among HIV+ MSM. Poster presented at the Annual Meeting of the Society of Behavioral Medicine, San Diego, CA.
• Vanable, P. A., Carey, M. P., Brown, J., Littlewood, R., Bostwick, R. A., and Blair, D. (2009). What HIV+ men who have sex with men say is needed to promote sexual risk reduction. Manuscript submitted for publication.

Items of the Sexual Health Knowledge Questionnaire for HIV+ MSM

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

Directions: For each statement, please tell us whether the statement is “True” or “False.” If you do not know the answer, please do not guess; please say “Don’t Know.”

1. Having an undetectable viral load reduces the risk of transmitting HIV.	True	False	Don’t Know
2. Having another STD makes it easier for an HIV+ person to give HIV to an HIV-negative partner.	True	False	Don’t Know
3. Infection with another STD can speed up HIV disease progression for a person who is HIV+.	True	False	Don’t Know
4. Human Papillomavirus (HPV) sometimes leads to rectal cancer in gay men.	True	False	Don’t Know
5. Having an undetectable viral load eliminates the chance that a person with HIV will infect a sexual partner.	True	False	Don’t Know
6. Among gay men, Hepatitis A is transmitted through rimming (oral-anal contact).	True	False	Don’t Know
7. Doctors have now proven that reinfection with another strain of HIV worsens the health of an HIV+ person.	True	False	Don’t Know
8. Unlike HIV, most other viral STDs can be cured.	True	False	Don’t Know
9. A person can get an STD through oral sex.	True	False	Don’t Know
10. An HIV+ person is less likely to transmit HIV to a sexual partner if he is the insertive partner (top) than if he is the receptive partner (bottom).	True	False	Don’t Know
11. Transmission of drug- resistant HIV to HIV-negative sexual partners is more common than transmission of drug- resistant HIV to HIV+ partners.	True	False	Don’t Know
12. If you’re HIV positive, infections like gonorrhea and chlamydia in your penis can decrease the amount of HIV in your semen.‌	True	False	Don’t Know
13. Syphilis is a bacterial STD.	True	False	Don’t Know
14. It is a good idea to use Vaseline or baby oil with latex condoms.	True	False	Don’t Know
15. Gonorrhea can be found in the throat.	True	False	Don’t Know
16. For two HIV+ partners, STDs are less of a concern than contracting drug- resistant HIV.	True	False	Don’t Know
17. HIV can be transmitted through oral sex, but the risks are much lower than for anal or vaginal sex.	True	False	Don’t Know
18. An HIV+ person who has sex with another HIV+ person should still use a condom to avoid new health problems.	True	False	Don’t Know