| The use of a measure of HIV transmission risk which incorporates seroadaptive behaviors is needed in order to assess the complex effects of disclosure on HIV transmission. The purpose of this study was to explore the use of a modified version of the ordinal scale of HIV risk behavior proposed by Osmond, Pollack, Paul, and Catania (2007) to operationalize the risk of HIV transmission among HIV-positive MSM and to establish the strength of the empirical evidence supporting the use of these scores for inference about HIV transmission. The original measure was modified to include the full potential for seropositioning (i.e., with and without 100% condom use) as a potential preventive strategy used by MSM to reduce the risk of HIV transmission. Additionally, the measure was applied to individual sexual encounters rather than globally so that the frequency of risk behaviors can be accurately modeled. The appropriateness of these methods was explored using data from a study involving the disclosure of serostatus to sexual partners in a sample of HIV-positive MSM. Results of the study are promising for the refinement of measurements of HIV transmission risk, and for the understanding of seroadaptive behavior in MSM. For researchers who are seeking to demonstrate the effectiveness of interventions designed to reduce HIV transmission risk, the ordinal measure provides a means for detecting qualitative shifts in sexual activity which can be critical to the question of effectiveness. |
