Sexual History Questionnaire

Sexual History Questionnaire

CAROLINE CUPITT,1 Oxleas NHS Foundation Trust, London

The Sexual History Questionnaire (SHQ) was devised to assess the degree to which an individual’s sexual behavior is putting him or her at risk of infection by HIV, the virus that leads to AIDS. Respondents are asked to self-report such behavior and, in addition, are questioned regarding their beliefs about their risk of contracting HIV.

Description

The SHQ was originally designed for use with college students and has since been used to study the sexual behavior of this population across several cultures, including the UK (Cupitt & de Silva, 1994), Turkey (Askun & Ataca, 2007), South Africa (Aitken, 2005), and North America (Ehrhardt, Krumboltz, & Koopman, 2006; Lam & Barnhart, 2006; Peterson, 2006).

The questionnaire first asks for information concerning basic demographic characteristics and is then divided into four sections. Section A begins by asking whether respondents have sex with men or women (see Exhibit instructions for the definitions used for “have sex”). This makes the important distinction between sexual identity and sexual behavior, which may be very different (Bancroft, 1989). Two questions follow, asking whether the respondent has ever had protected or unprotected penetrative sex.

Section B asks for details of all sexual encounters over the past month. Because retrospective self-report of sexual behavior has been criticized for its unreliability, Section C then asks about the last occasion the respondent had sex. This allows for more detailed questioning about interpersonal and situational variables involved in the last sexual encounter.

Finally, Section D includes a brief set of questions relating to contact with HIV counseling, sufferers, and risk assessment. There is substantial evidence that sexual- behavior change is affected by knowing someone who has died of HIV (e.g., Becker & Joseph, 1988) and some evidence that it may be affected by HIV antibody test counseling. Respondents are asked to make a general assessment of their perceived risk for HIV/AIDS using a standard scale.

Response Mode and Timing

A combination of multiple-choice, yes/no, 5-point scale, and numerical questions are used. The questionnaire takes between 5 and 10 minutes to complete, depending on the complexity of the respondent’s sexual history.

Scoring

The questionnaire was not originally designed to be scored. However, the information in Section B gives an indication of the respondent’s current risk of HIV infection. If a respondent has had unprotected penetrative sex in the past month, he or she can be said to be at high risk. This assumes that the risk from oral sex is not significant.

Peterson (2006) describes calculating a sexual risk composite score using the responses to four items, which are then assigned values as follows: age of first penetrative sex (question 2: values range from 6 to 1), number of sexual partners (question 4: values range from 1 to 6), history of unprotected penetrative sex (question 3: 3 or 0), and unprotected penetrative sex in the last encounter (question 9: 3 or 0). By assigning values within the ranges given, weight is given to items that have been demonstrated to be associated with increased risk of contracting sexually transmitted infections and/or unplanned pregnancies (DiClemente, 1992; Roosa, Tein, Reinholtz, & Angelini, 1997).

Reliability

By its nature, the behavior this questionnaire seeks to measure is ever changing. In an endeavor to increase the reliability of the information gained, there is a focus on the last occasion the respondent had sex. In the original research (Cupitt, 1992), the final section, D, was submitted to a test- retest reliability measurement. The questions in Section D were repeated over a 2-week interval with a group of 18 postgraduate students, and all were found to have an intra- class correlation of above .80 (p < .001), indicating a high level of reliability.

Validity

Most of the questions are considered to have high face validity. To ensure that the respondent shared the same understanding of the different sexual practices mentioned, a summary of definitions was included at the beginning of the questionnaire. Critically, these definitions distinguish penetrative from nonpenetrative forms of sexual contact. The concept of penetrative partner has been advocated by Project SIGMA (Socio-Sexual Investigations of Gay Men and AIDS; Hunt, Davies, Weatherburn, Coxon, & McManus, 1991). They argue that the notion of sexual partner per se is not valid to estimate risk behavior for HIV and that the concept of a penetrative sexual partner is consider- ably more accurate.

Address correspondence to Caroline Cupitt, Consultant Clinical Psychologist, Oxleas NHS Foundation Trust, Assertive Outreach Team, Erith Centre, Park Crescent, Bexley, Kent, UK, DA8 3EE; e-mail: [email protected]

Sexual History Questionnaire

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.

References

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. Retrieved from http://etd.uwc.ac.za/usrfiles/modules/etd/docs/etd_init_3582_ 1174044987.pdf

Askun, D., & Ataca, B. (2007). Sexuality related attitudes and behav- iors 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.