Development and Testing of an HIV-Risk Screening Instrument for Use in Health Care Settings Barbara Gerbert, PhD, Amy Bronstone, PhD, Stephen McPhee, MD, Steven Pantilat, MD, Michael Allerton, MS Objective: To develop and test a brief, reliable, and valid HIV-risk screening instrument for use in primary health care settings. Design: A two-phase study: (1) developing a self-administered HIV-risk screening instrument, and (2) testing it with a primary care population, including testing the effect of confidentiality on disclosure of HIV-risk behaviors. Setting: Phase 1: 3 types of sites (a blood donor center, a methadone clinic, and 2 STD clinics) representing low and high HIV-seroprevalence rates. Phase 2: 4 primary care sites. Participants: Phase 1: 293 consecutively recruited participants. Phase 2: 459 randomly recruited primary care patients. Main Outcome Measure: Phase 1: comparison of the responses of participants from low and high HIV-seropreva- lence sites. Phase 2: primary care patients’ rates of disclosure of HIV-risk behaviors and ratings of acceptability. Results: Phase 1: through examining item-confirmation rates, item-total correlations, and compar- ison of responses from low and high HIV-seroprevalence sites, we developed a final 10-item HIV-risk Screening Instrument (HSI) with an internal consistency coefficient of .73. Phase 2: 76% of primary care patients disclosed at least 1 risky behavior and 52% disclosed 2 or more risky behaviors. Patients were willing to disclose HIV-risk behaviors even knowing that their physician would see this information. Ninety-five percent of our patient participants were comfortable with the questions on the HSI, 78% felt it was important that their doctor know their answers, and 52% wished to discuss their answers with their physician. Conclusion: Our brief, self-administered HSI is a reliable and valid measure. The HSI can be used in health care settings to identify individuals at risk for HIV and to initiate HIV testing, early care, and risk-reduction counseling, necessary goals for effective HIV prevention efforts. Medical Subject Headings (MeSH): health care delivery, screening (HIV), HIV, risk assessment, risk behavior, instruments (screening). (Am J Prev Med 1998;15:103–113) © 1998 American Journal of Preventive Medicine T he human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) ex- acts a heavy toll in human and economic costs. The Centers for Disease Control estimate that from 1984 to 1992 between 650,000 and 900,000 (approxi- mately 0.3%) of Americans were infected with HIV. AIDS is now the leading cause of death for 25- to 44-year-old men in the United States and is the third leading cause of death for women in the same age group. 1,2 The economic cost of this epidemic also is staggering, with over 7 billion dollars spent annually on the care of people infected with HIV. 3,4 Although new drug protocols offer hope that HIV may be suppress- ible, 5,6 prevention must remain a top priority of public health efforts. Cost-effective prevention efforts require that at-risk individuals be identified early so that they can receive appropriate care and preventive services, such as HIV testing and risk-reduction counseling. Many of the estimated 650,000 –900,000 people with HIV infection in the United States are unaware of their infection, 7,8 and thus are not receiving services that may improve their health and prevent further spread of the virus. Health care settings offer ideal locations to initiate From the Division of Behavioral Sciences, School of Dentistry (Ger- bert, Bronstone), University of California, San Francisco, California 94111; the Division of General Internal Medicine, Department of Medicine (McPhee, Pantilat), University of California, San Francisco, California 94111; Program in Medical Ethics, Department of Medi- cine (Pantilat), University of California, San Francisco, California 94111; and Kaiser Permanente Medical Group, Inc., Kaiser Perma- nente Medical Center (Allerton), Oakland, California 94612. Address correspondence to: Barbara Gerbert, PhD, Professor and Chair, Division of Behavioral Sciences, University of California, San Francisco, 601 Montgomery, Suite 810, San Francisco, California 94111. 103 Am J Prev Med 1998;15(2) 0749-3797/98/$19.00 © 1998 American Journal of Preventive Medicine PII S0749-3797(98)00025-7