Workshop on the Development of the Posit HIV/STD-Risk Mini-Questionnaire

United States

Elizabeth Rahdert, Ph.D.

Although adolescents 12 through 19 years represent less than 1 percent of the cumulative total reported AIDS cases in the United States, many youths are at risk of sexually transmitted HIV infection. About 18 percent of reported AIDS cases involve young adults age 20 to 29 years, but because of the roughly 10 years between HIV seropositivity and onset of AIDS-related symptoms, it is thought that many of these young adults acquired HIV infection as teenagers. Other evidence of elevated risk includes the relatively high rates of other sexually transmitted diseases (STDs). These statistics highlight the importance of identifying as early as possible adolescents at risk for HIV infection or other STDs so that early preventive or therapeutic measures can be taken. Unfortunately, no developmentally appropriate HIV/STD-risk screen is currently available that can be used by practitioners and researchers in the wide range of settings in which potentially at-risk adolescents are or might be seen.

Toward producing an adolescent-appropriate HIV/STD-risk screen, the Problem Oriented Screening Instrument for Teenagers (POSIT) was chosen to serve as the prototype for an HIV/STD-risk questionnaire. The POSIT was selected because it is a validated, reliable 139-item, self-report screening instrument designed for adolescents and has been shown to have utility in mental and medical heath care settings, schools and social service agencies, drug treatment programs, and juvenile justice assessment centers. The POSIT screens for potential problems in ten functional areas (i.e., drug use/abuse; mental health; physical health; family relations; peer relations; social skills; educational status; vocational status; leisure/recreation; aggressive behavior/delinquency), thus providing clinicians and researchers with a valuable tool for use in identifying problems potentially in need of preventive, therapeutic or supportive services. The intention of convening this Workshop was to begin the process of developing a POSIT-like problem screen for an eleventh functional area, that being a short, detachable HIV/STD-risk mini-questionnaire that could be administered and scored with or without administering the POSIT.

To accomplish this goal the Workshop, comprised of researchers and clinicians with expertise in the area of HIV infection and other STDs in high and low risk adolescent populations, was held July 31, 1997. The meeting was co-chaired by Drs. Elizabeth Rahdert and Dorynne Czechowicz, Division of Clinical and Services Research. Through the Delphi Method (i.e., review, discussion, and voting), Workshop participants (1) identified over 20 behavioral categories (e.g., introduction to sex; drug use & sex; forced sex; condom use & sex) known from research findings and clinical experience to be associated with risk for HIV/STD exposure in younger (12-15 years) and older (16-19 years) male and female adolescents; (2) created 180 items representing those behaviors that had been identified as risk for HIV/STD exposure; then (3) selected from the pool of 180 items 30 that could be formatted like items on the POSIT. The task that remains for Workshop participants is to carefully reword items so that each question can elicit the most reliable response.

When the "final" 30-item POSIT HIV/STD-risk screening tool is produced by the Workshop participants, it will be examined by adolescent focus groups to improve it's "readability." The refined 30-item questionnaire will then undergo small scale pilot testing to start the process of reducing the 30-item version to something like a 15-item POSIT HIV/STD-risk mini-questionnaire. Pilot testing may be accomplished through support from administrative supplements to existing projects that already focus on adolescent subjects. After those developmental steps have been completed, researchers will be encouraged to submit grant proposals, the primary aim of which will be to establish the psychometric properties of this (approximately) 15-item POSIT HIV/STD-risk screen.