Sexual History Questionnaire

Abstract

The Sexual History Questionnaire (SHQ) is a self-report instrument developed by Caroline Cupitt to evaluate an individual’s current and historical sexual behavior in relation to the risk of acquiring HIV, the precursor to AIDS. Originally designed for use with college students, the SHQ has been applied internationally across diverse populations in the UK, Turkey, South Africa, and North America.

The questionnaire is structured into four distinct sections that collect demographic data, distinguish between sexual identity and behavior, detail sexual activity over the past month, focus intensely on the most recent sexual encounter to enhance reporting accuracy, and assess the respondent’s contact with HIV counseling and their perceived personal risk.

Keywords

Sexual History Questionnaire, SHQ, HIV risk assessment, AIDS prevention, college students, sexual behavior, safer sex practices, perceived risk, penetrative sex, self-report.

Authors

CAROLINE CUPITT

Purpose

The primary purpose of the Sexual History Questionnaire (SHQ) is to quantify and qualify the extent to which an individual’s sexual practices expose them to the risk of HIV infection. It systematically collects detailed self-reported data on various forms of sexual contact, partner types, and condom use, allowing researchers and clinicians to identify specific high-risk behaviors.

Additionally, the SHQ aims to explore cognitive and situational factors surrounding sexual behavior. Section D specifically addresses the respondent’s beliefs, contact with HIV counseling, and their generalized assessment of personal sexual risk, factors known to influence behavioral change.

Construct

The SHQ measures the construct of Sexual Risk Behavior and Perception, focusing on the following key dimensions:

• Sexual Identity vs. Sexual Behavior: Distinguishing whom the respondent has sex with (men, women, or both) from their inherent sexual identity.
• Penetrative Risk Exposure: Quantifying the frequency of protected and unprotected penetrative sex (vaginal and anal) over both a lifetime and the preceding month.
• Situational Variables: Capturing detailed interpersonal dynamics, partner characteristics (regular vs. casual), and communication regarding safer sex during the most recent sexual encounter.
• Perceived Risk and Influence: Assessing the respondent’s general perceived risk of HIV/AIDS and whether contact with HIV counseling or knowing an HIV/AIDS sufferer has impacted their behavior.

Validity

The SHQ is reported to possess high face validity, meaning the questions appear, on the surface, to measure what they are intended to measure—sexual history and risk behaviors related to HIV transmission.

A crucial aspect of the SHQ’s validity is the precise definition of terms provided to respondents, particularly the clear distinction between penetrative and nonpenetrative sexual contact. This methodological clarity addresses criticisms regarding the accuracy of risk estimation. Research, such as that by Project SIGMA (Hunt et al., 1991), supports the SHQ’s approach, arguing that using the concept of a penetrative sexual partner is significantly more accurate for estimating HIV risk than relying on the general notion of a “sexual partner” per se.

Reliability

Due to the inherently transient nature of sexual behavior, the SHQ structure deliberately focuses on the most recent sexual encounter (Section C) to enhance the reliability of the self-reported data.

Formal test-retest reliability was specifically measured for Section D (questions related to HIV counseling and risk assessment) in the original research (Cupitt, 1992). This section was administered twice over a two-week interval to a group of 18 postgraduate students. The results demonstrated a high level of consistency, with all questions in Section D yielding an intra-class correlation (ICC) of above .80 (p < .001).

Factor Analysis

The Sexual History Questionnaire was not originally designed to yield a single comprehensive score, and a formal factor analysis of the entire instrument is not described in the source documentation. However, specific methods for synthesizing the behavioral data have been established by subsequent researchers.

Peterson (2006) developed a sexual risk composite score using four key items from the questionnaire, assigning weighted values based on their known association with increased risk of sexually transmitted infections (STIs) and unplanned pregnancies. The items utilized are age of first penetrative sex, total number of sexual partners, history of unprotected penetrative sex, and incidence of unprotected penetrative sex in the last encounter.

Instrument

Test Type: Self-report questionnaire, behavioral and risk assessment.

Format: Multi-method response combining multiple-choice, Yes/No, numerical fill-in, and a 5-point Likert-type scale.

Language Available: English (Original), used in translations or adaptations in Turkish and others implied by international use.

Population Group: Young adults and students.

Age Group: College/University age and older adolescents.

Population Details: Originally used with college students. Has been validated and applied across diverse cultural settings including the UK, Turkey, South Africa, and North America.

Test Methodology: The questionnaire is divided into four sections (A, B, C, D) and takes approximately 5 to 10 minutes to complete, depending on the complexity of the respondent’s history.

Permissions & Fee and Test Year

Test Year: Circa 1992 (Based on original Master’s thesis).

Permissions/Fee: Not specified. Contact the author for usage permissions.

Authors

Author ORCID Identifier: Not provided in the source material.

Affiliation Email addresses: [email protected]

Correspondence Address: Caroline Cupitt, Consultant Clinical Psychologist, Oxleas NHS Foundation Trust, Assertive Outreach Team, Erith Centre, Park Crescent, Bexley, Kent, UK, DA8 3EE.

Reference’s

The following publications and academic works are cited in relation to the development, use, and validation of the Sexual History Questionnaire:

• Aitken, L. (2005). The influence of HIV knowledge, beliefs, and religiosity on sexual risk behaviours of private school adolescents. Minithesis, University of the Western Cape, Bellville, South Africa. The original PDF can be downloaded here: http://etd.uwc.ac.za/usrfiles/modules/etd/docs/etd_init_3582_1174044987.pdf
• Askun, D., & Ataca, B. (2007). Sexuality related attitudes and behaviors of Turkish university students. Archives of Sexual Behavior, 36, 741–752.
• Bancroft, J. (1989). Human sexuality and its problems (2nd ed.). Edinburgh, UK: Churchill Livingstone.
• Becker, M. H., & Joseph, J. G. (1988). AIDS and behavioral change to reduce risk: A review. American Journal of Public Health, 78, 394– 410.
• Cupitt, C. (1992). Cognitive factors in the decision to adopt safer sex practices. Unpublished master’s thesis, University of London, UK.
• Cupitt, C., & de Silva, P. (1994). Zilbergeld’s myths and sexual activity in the age of AIDS: An empirical study. Sexual and Marital Therapy, 9, 17–31.
• DiClemente, R. J. (1992). Psychosocial determinants of condom use among adolescents. In R. J. DiClemente (Ed.), Adolescents and AIDS: A generation in jeopardy (pp. 34–51). Newbury Park, CA: Sage.
• Ehrhardt, B. L., Krumboltz, J. D., & Koopman, C. (2006). Training peer sexual health educators: Changes in knowledge, counseling self- efficacy and sexual risk behavior. American Journal of Sexuality Education, 2, 39–55.
• Hunt, A. J., Davies, P. M., Weatherburn, P., Coxon, A. P., & McManus, T. J. (1991). Sexual partners, penetrative sexual partners and HIV risk. AIDS, 5, 723–728.
• Lam, A. G., & Barnhart, J. E. (2006). It takes two: The role of partner ethnicity and age characteristics on condom negotiations of heterosexual Chinese and Filipina American college women. AIDS Education and Prevention, 18, 68–80.
• Peterson, S. H. (2006). The importance of fathers: Contextualizing sexual risk taking in “low risk” African-American adolescent girls. Journal of Human Behavior in the Social Environment, 13(3), 67–83.
• Roosa, M. W., Tein, J., Reinholtz, C., & Angelini, P. J. (1997). The relationship of childhood sexual abuse to teenage pregnancy. Journal of Marriage and the Family, 59, 119–130.

Items of the Sexual History Questionnaire

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

Instructions: This questionnaire asks questions about your recent sexual history. Your answers are entirely confidential. Some words used in this questionnaire may not be familiar to you, or you may not be sure of their exact meaning. The following definitions may be helpful: Vaginal sex is sex in which the penis enters the vagina. Oral sex is sex in which the mouth or tongue is in contact with the genitals. Anal sex is sex in which the penis enters the anus, or back passage. Penetrative sex is sex in which the penis enters the vagina or anus. Nonpenetrative sex includes oral sex, and also many other forms of sex such as massage, touching, and mutual masturbation. Protected sex refers to sex with a condom or oral sex with a latex barrier or condom. A regular partner, for the purposes of this study, is someone with whom you have had sex more than once.

Please indicate your gender male/female

your age years

your status undergraduate/postgraduate the religion which influences you most (please circle):

1 Christianity 2 Judaism 3 Islam 4 Hinduism 5 Other

Section A

1. Who do you have sex with? (please circle):

   1 only men 2 mostly men 3 equally men and women 4 mostly women 5 only women

2. Have you ever had penetrative sex (sex in which the penis penetrates the vagina or anus)? Yes/no

   If yes, at what age did you first have penetrative sex?

3. Have you ever had unprotected penetrative sex (penetrative sex without a condom)? Yes/no

   Section B

   The following questions relate to your sexual encounter(s) over the last month. This includes nonpenetrative sex such as oral sex and mutual masturbation. If you have not had sex in the last month please move on to Section C. If you have never had sex please move on to Section D.

4. In the last month how many sexual partners have you had?

5. How many of these were regular partners (people with whom you have had sex more than once)?

6. (a) How many times have you had sex with a regular partner in the last month?

   1. On how many of these occasions did you have penetrative sex?

   2. On how many of these occasions did you use a condom?

7. (a) How many times have you had sex with other partners in the last month?

   1. On how many of these occasions did you have penetrative sex?

   2. On how many of these occasions did you use a condom?

   Section C

   The following questions refer specifically to your last sexual encounter.

8. How long ago was your last sexual encounter? Please circle. 1 less than a week ago

   1. between one week and one month ago

   2. between one month and three months ago 4 between three months and six months ago 5 between six months and one year ago

   6 more than one year ago

9. What kind(s) of sex did you have on this occasion? Please answer yes or no to the following activities: Unprotected vaginal sex yes/no

   Vaginal sex with a condom yes/no

   Unprotected anal sex yes/no

   Anal sex with a condom yes/no

   Oral sex yes/no

   Other forms of nonpenetrative sex (such as massage and mutual masturbation) yes/no

10. What gender was your partner on this occasion? Male/female

11. On this occasion did you or your partner mention using a condom?

    1. you

    2. your partner

    3. neither

12. On this occasion did you or your partner mention practicing nonpenetrative sex?

    1. you

    2. your partner

    3. neither

13. Was s/he a regular sexual partner (a partner with whom you have had sex more than once)? Yes/no

    If yes, have you discussed practicing safer sex with this partner (using condoms or latex barriers, or having nonpenetrative sex)? Yes/no

14. If you had heterosexual vaginal sex on this occasion, did you use a form of contraception? Please circle one or more:

    1. the condom

    2. the pill

    3. the diaphragm or cap

    4. IUD (the coil)

    5. spermicidal sponge, creams, or pessaries

    6. the rhythm (calendar) method

    7. the withdrawal method

    8. other (please specify)

    9. none

15. With this partner, have you discussed what kind of sex you like and don’t like Yes/no

    Using the scale below, write a number beside each statement to indicate how you felt.

    1 2 3 4 5

    Not at all A Great Deal

16. How much did you feel like having sex on this occasion?

17. How much did your partner feel like having sex on this occasion?

18. With this partner on this occasion, how able did you feel to express your wishes regarding sex?

    Section D

    Using the same scale, answer the following, more general question.

    1 2 3 4 5

    Not at all A Great Deal

19. How much at risk do you consider yourself from HIV/AIDS?

20. Have you ever had an HIV antibody test? Yes/no

21. Did you get the result of the test? Yes/no/nonapplicable

22. To your knowledge, do you know or have you known anyone personally with HIV or AIDS? Yes/no

23. Please feel free to add anything which may give a clearer picture of your answers to this questionnaire.