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Utility of behavioral changes as markers of sexually transmitted disease risk reduction in sexually transmitted disease/HIV prevention trials.
Journal of Acquired Immune Deficiency Syndromes 2002;31:71-79.
Pinkerton SD, Chesson HW, Layde PM, and the National Institute of Mental
Health
Abstract
Most sexually transmitted disease (STD)/HIV sexual risk reduction intervention
trials are evaluated using behavioral outcomes as their main indicators of
intervention effectiveness. How good are behavioral measures as surrogate
markers for STD infection? Do the behavioral changes that are commonly assessed
in risk reduction interventions accurately reflect changes in STD risk? We
applied a mathematical model of STD/HIV transmission to empiric data from
a large HIV prevention intervention to estimate pre- to postintervention
changes in intervention participants' STD risk. We then used the coefficient
of determination (R(2)) to assess the strength of association between changes
in STD risk and changes in three behavioral measures: proportion of acts
of intercourse for which condoms were used, number of sex partners, and number
of acts of unprotected intercourse. The results indicate that change in the
number of acts of unprotected intercourse is a superior marker of STD risk
changes for less infectious STDs such as HIV, whereas change in the number
of partners may be preferable for highly infectious STDs such as gonorrhea.
Changes in the proportion of acts of intercourse for which condoms were used
were not strongly correlated with changes in STD risk under most of the conditions
examined in this analysis. The utility of different measures of sexual behavior
change as markers for changes in STD risk and, hence, expected incidence,
depends on the infectivity and prevalence of the target STD.