Instrument validity: HIV and other sexually transmitted infections in homeless people

Patrício, Anna Cláudia Freire de Araújo; Silva, Richardson Augusto Rosendo da; Pereira, Ivoneide Lucena; Silva, Luipa Michele; Lima, Maria Alzete de; Leite, Maria Amanda Pereira; Brasil, Maria Hellena Ferreira; Souza, Suzanna Valéria Oliveira

doi:10.1590/0034-7167-2021-0863

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (6) • 2022 • https://doi.org/10.1590/0034-7167-2021-0863 linkcopy

Instrument validity: HIV and other sexually transmitted infections in homeless people

Validación de instrumentos: VIH y otras infecciones de transmisión sexual en personas sin hogar

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to validate, through the Item Response Theory, an instrument on vulnerability to HIV and other sexually transmitted infections in homeless people.

Methods: a cross-sectional study carried out between February and May 2018 with 100 homeless people in a municipality in northeastern Brazil. A sociodemographic questionnaire was applied, and another with items referring to behaviors vulnerable to HIV and sexually transmitted infections (STIs). Subsequently, it was assessed through the Item Response Theory.

Results: the items previous diagnosis of STIs (F=0.473), partner with STI symptoms (F=0.518), drug use (F=0.509), sex for money (F=0.552), STI symptoms (F=0.448), number of sexual partners (F=0.616), sharps sharing (F=0.398) and being a victim of sexual violence (F=0.347) were validated.

Conclusions: the instrument proved to be validated, being able to identify vulnerability to HIV and other sexually transmitted infections in homeless people.

Descriptors: Homeless Persons; HIV; Validation Study; Health Vulnerability; Sexually Transmitted Diseases.

Variables	n	%
RAPID TESTS
Syphilis
Negative	70	70
Positive	29	29
Did not do it	1	1
HIV^* * HIV - Human Immunodeficiency Virus; STIs - sexually transmitted infections.
Negative	94	94
Positive	5	5
Did not do it	1	1
Hepatitis B
Negative	98	98
Positive	1	1
Did not do it	1	1
Hepatitis C
Negative	99	99
Did not do it	1	1
Positive	-	-
BEHAVIORS VULNERABLE TO HIV AND OTHER STIS^* * HIV - Human Immunodeficiency Virus; STIs - sexually transmitted infections.
Age of first sexual intercourse?
Less than 18 years old	91	91
13 years	21	21
12 years	19	19
14 years	14	14
15 years	14	14
17 years	8	8
16 years	6	6
11 years	5	5
10 years	3	3
9 years	1	1
Older than or equal to 18 years	9	9
18 years	6	6
20 years	2	2
19 years	1	1
Have you had previous diagnosis of any STI?
No	75	75
Yes	25	25
Which STI have you ever had?
Syphilis	12	12
Gonorrhea	7	7
Candidiasis	5	5
Trichomoniasis	1	1
Do you use condom in every sexual relation?
No	75	75
Yes	25	25
Do you use condoms in anal sex?
No	35	35
Yes	28	28
Sometimes	27	27
Did not do it	10	10
Do you use condoms during vaginal sex?
No	37	37
Yes	32	32
Sometimes	31	31
Do you use condoms during oral sex?
No	45	45
Sometimes	25	25
Yes	24	24
Did not do it	6	6
What are the reasons for not using condoms?
Trust	39	39
Prefer skin to skin	23	23
No time to put	21	21
Not applicable	11	11
They might think I am HIV positive	4	4
Condom is not available	1	1
Reduces pleasure	1	1
Have you ever presented any STI symptom (discharge, burning, itching)?
No	57	57
Yes	43	43
Number of sexual partners?
One	74	74
More than one	26	26
Needle reuse?
No	95	95
Yes	5	5

Items	Discrimination (a)	Difficulty (b)	Factor loading (F)
Previous diagnosis of STIs^* * STIs - sexually transmitted infections.	0.917	1.402	0.473
Partner with STI symptom	1.032	-0.390	0.518
Illicit drug use	1.007	-1.251	0.509
Customer/partner uses drugs	1.358	-0.172	0.624
Sex for money	1.128	1.519	0.552
STI symptoms	0.854	0.376	0.448
Number of sexual partners	1.330	1.940	0.616
Sharps sharing	0.739	4.316	0.398
Victim of sexual violence	0.630	2.968	0.347
% variation explained	-	-	25.6
p-value	-	-	0.054
RMSEA	-	-	0.0691
RMSR	-	-	0.0926
TLI	-	-	0.7074
CFI	-	-	0.7805

HIV test score ^* * HIV - Human Immunodeficiency Virus.	Standard test (ELISA)
HIV test score ^* * HIV - Human Immunodeficiency Virus.	Positive	Negative
Positive ≥ 4	3	30
Negative < 4	2	64
Parameter	%	95% CI
Sensitivity	60.00	14.66 a 94.72
Specificity	68.08	57.67 a 77.32
Accuracy	67.68	57.53 a 76.73
Positive predictive value (PPV)	9.09	1.92 a 24.33
Negative predictive value (NPV)	96.97	89.48 a 99.63

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Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[TFN1] ^*
HIV - Human Immunodeficiency Virus; STIs - sexually transmitted infections.