Using structural equation modeling techniques to evaluate HIV risk models

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Abstract
Structural equation modeling (SEM) techniques were used to compare 5 methods of assessing HIV/AIDS sexual risk in a large prediction model. These were: (a) multiple measures; (b) a single latent factor; (c) modifying the computation of the dependent variables used in Methods 1 and 2 to weight sexual encounters by specific partner risk; (d) use of risk composites, obtained by multiplying number of sexual partners by number of occasions of unprotected sex; and (e) use of risk indexes that assign a number based on responses to general questions about risk behaviors. Data from 452 at‐risk women from a New England community were analyzed in 5 versions of an HIV/AIDS sexual risk prediction model. Models were compared in terms of SEM empirical fit indexes (x2 [df], average absolute standardized residuals, and Comparative Fit Index); significant paths, explained variance, theoretical fit, and simplicity. Results indicate that: (a) multiple measures and latent factor models are preferable to all others by each of the standards of comparison, (b) in the composite dependent variable models, including information about the partners' number of partners provided little additional explained variance beyond knowing the number of occasions of unprotected sex, and (c) dependent measures that did not remain close to Centers for Disease Control criteria may not be adequately predicting HIV/AIDS sexual risk. Several recommendations are presented for selecting an appropriate conceptualization of HIV/AIDS sexual risk.