Principal Investigators: Anthony P.Macmillan Coxon, PhD

1. Principal Investigators: • Anthony P.Macmillan Coxon, PhD • Hon. Professorial Fellow, Graduate School of SPS, University of Edinburgh • Thomas J. McManus, FRCOG • Consultant, Royal London Hospital • Project SIGMA, Edinburgh and Sigma Research (London) together constitute PROJECT SIGMA • Researching and Serving the Gay and Bisexual Community for 18 years Sociology, University of Edinburgh

2. What’s • UNIQUE • about……. Sexual Diaries? • by • Professor Tony Macmillan Coxon • SSPS, University of Edinburgh, Project Sigma SPECIAL PARTICULAR Sociology, University of Edinburgh

3. DIARIES • Only good girls keep diaries. Bad girls don’t have the time. • Tallulah Bankhead (1903 – 1968) US Actress What is a diary as a rule? A document useful to the person who keeps it, dull to the contemporary who reads it, invaluable to the student, centuries afterwards, who treasures it!Ellen Terry (1847–1928) British actress,The Story of My Life, Ch. 14 Sociology, University of Edinburgh

4. I never travel without my diary. One should always have something sensational to read in the trainOscar Wilde (1895) The Importance of Being Earnest Sociology, University of Edinburgh

5. 0: BACKGROUND • From earliest SIGMA pre-tests in 1982, estimates and self-reports of frequency of sexual behaviours were shown to be [1988b]: • unreliable (test-retest;repeat questions in interview) • retrospection- biased • detail and accuracy of reports dependent (inversely) on elapse time • 1-week retrospective “work-back from today” showed even 3-day lapse distorted detail and only gross properties survived • “chunked” (suspicious rounding of numbers and “grossing up” Sociology, University of Edinburgh

6. ... This led to basic re-thinking & development: • development of a schema/model of “structure of sexual behaviour” [1992] (which determined both form of Sexual Behaviour Inventory used in interview schedule AND format for sexual diary method) Sociology, University of Edinburgh

7. method of sexual diaries (Self-administered; month-long) to make possible .... • reliable, valid, accurate measurement of • detailed sexual behaviour and sequences of behaviour • in a contextual and relational setting. • Reduce retrospection bias; S.D.s are a non (interviewer)-reactive method (cf interpretation of “the condom broke”) Sociology, University of Edinburgh

8. COLLECT / elicit(sexual diaries) (Qualitative) Transcribe ENCODE   Tag SELECT   ANALYSE  (Integrate)  Analyze (SDA Programs) (Atlas/ti &c) HOW? Sequence of Using Sexual Diary Methodology Sociology, University of Edinburgh

9. Abbreviated example of a one-week of a sexual diary Sociology, University of Edinburgh

10. ANALYSIS • By means of a SCHEMA common to Project SIGMA Sexual Inventory and Sexual Diaries [JSR 1992] • The Schema has linguistic analogies: • Sexual Session = Sentence • Sexual Act = Word • Sexual Behaviour = Word-stem • Schema puts eliciting format and encoding structure for sexual scripts into 1:1 correspondence Sociology, University of Edinburgh

11. SIGMA schema of sexual behaviour (relevant to sexual transmission of HIV) Sociology, University of Edinburgh

12. The SCHEMA has a well-defined grammar …..usually shielded from the enquirers’ eyes… Formal Grammar of Revised Sexual Diary Code <session> ::= <act> <act> ' ' < session> <act> ::= '(' <act> ')' '/' <accomps> <act> '/' <accomps> <partner_label> <session> <act> '&' <act> <modality> <behaviour> <modality> <behaviour> ',' <outcomes> …………/cont. Sociology, University of Edinburgh

13. OUTCOME (risk order) Code Destination N No ejaculation X Ejaculation `elsewhere' I On Me (ie: on EGO) O On Him (ie: on ALTER) C into a Condom H In Him (ie: in ALTER) M In Me (ie: in EGO) Sociology, University of Edinburgh

14. PROGRAM NAME FULL NAME & DESCRIPTION SDA (pp) BAPN Both-Active-Passive-Neither: Modality (Sexual Role) Analysis by sexual act 5,35 COLLECT Sexual Session length distribution and Mean length 36 CONDOM Percentage of sessions in which a condom was used 36 COOCUR Co-occurrence of sexual acts in a session. (Different definitions of co-occurrence: act-specific and session specific) 7-8; 37 CPSANAL Co-occurrence (similarity, symmetric), Precedence (asymmetric: how often a precedes b); Successor (asymmetric: how often a succeeds b). Output matrix to Scaling and Clustering programs. 7-8; 39 EVER Prevalence (How often a sexual act has ever been done) 39 Sociology, University of Edinburgh

15. FREQACT Frequency of (sexual) act by modality 40-41 GINI / LORENZ Frequency (and cumulative) frequency of Individuals who do exactly n acts and of Acts (basis for Lorenz distribution, qv) and Gini Coefficient Suppl. KWIC Key-word-in-context: Instances of specified modality/act in context of session, centred and referenced 43 MARKER Analysis of sexual acts that start and end sessions, and of the “destination” of the ejaculate/s, if it/they occur 44-5 MEDPOL Median Polish Tukey Means analysis of 2-way table, defined by SIGMA types Suppl. RISK Frequency of type and destination of outcome (ejaculation) by sexual act ( Anal Intercourse, Fellatio or Masturbation; denominator can be N Acts or N Individuals 8, 45-46 SESSTYPE Session-Type: typology of sessions in terms of: Solo-Quick(1-act) - Role (preponderance of Active or Passive role) - Reciprocated - Other 9, 47 Sociology, University of Edinburgh

16. WHAT FOR? Applications • Primarily... • Counts of incidence and prevalence of sexual practices & variants, on both {Individual/month} and {Acts/month} bases • In contextual / sequential / vocational environment • Within/Across subgroups (HIV+, condom usage, age, relationship-type ...) Sociology, University of Edinburgh

17. For example: • Role-separation (“gendering” ( [1993]) • Concentration of potential and actual risk behaviour[1999] • Inferring the contextual “rules” of risk [1994b, 1995b] • Factors influencing risk behaviour (e.g. substance use; alcohol) [1994a] • Partner-specific sexual behaviour [1988] • Differential: location/arenas – home; club; saunas, • Public Sex Environments (cottaging, tea-room) [1996] • times – weekends, holidays, at parents • Different subgroups: SM/Leather [1996], Minority Ethnic groups; Young gay men Sociology, University of Edinburgh

18. BRIEF EXAMPLE ... Concentration • Example which combines Individual with Acts data derived from diaries. • Concentration is akin to Property/Income distribution: What Percent of Individuals “own” what Percent of Risk Activity? • Inter-relating two distributions cumulatively • Useful Equality baseline ... where n% of individuals own n% of risk activity ... allows us to see how far actual concentration departs from equal shares ... Gini Coefficient. Sociology, University of Edinburgh

19. BRIEF EXAMPLE ... Concentration/cont. • This needs two cumulative distributions • ... cross-related to each other • to produce Lorenz diagram and • measure of departure from “equal shares” • and then go on to examine characteristics of the distribution and who the “risk-rich” are Sociology, University of Edinburgh

20. Distributions of acts of anal intercourse to ejaculation (AIE) per month (i) No ofacts of anal inter-course (to ejaculation) per/month (ii)N of men  (diary/ m) (Iii) Percent of men (iv) Cumulative % of men (v) N of acts of anal in-tercourse (vi) Percent of acts (vii) Cumulative % acts 1 244 38.9 38.9% 244 9.8% 9.8% 2 136 21.7 60.5 272 11.0 20.8 3 62 9.9 70.4 186 7.5 28.3 4 49 7.8 78.2 196 7.9 36.2 5 34 5.4 83.6 170 6.9 43.1 6 20 3.2 86.8 120 4.8 47.9 7 11 1.8 88.5 77 3.1 51.0 8 13 2.1 90.6 104 4.2 55.2 9 7 1.1 91.7 63 2.5 57.7 10-19 36 5.7 97.5 466 18.8 76.5 20-49 14 2.2 99.7 405 16.3 92.8 50-104 2 (=628) 0.3 100.0 178 =2481 7.2 100.0 Mean = 3.8, Md = 2 acts of AI/month. IQR = 3 Sociology, University of Edinburgh

21. Constituent Distributions of anal intercourse Percentage of acts of AI accounted for by those who do exactly x acts a month Sociology, University of Edinburgh

22. Percentage of individuals who do exactly x acts of AI a month Sociology, University of Edinburgh

23. Lorenz curve of all acts of Anal Intercourse/month Sociology, University of Edinburgh

24. Characteristics of four types of AIE TYPE OF AIE[1] UNPROTECTED WITH CONDOM Summary Characteristics: ACTIVE PASSIVE ACTIVE PASSIVE NUMBERS INVOLVED: No. of fuck-acts/month No. of individuals 434 188  442 154 362 163 380 172 SUMMARY INFO: Average no. acts/month Dispersion (IQR) 2.31, Md=1 1 2.87, Md=1 2 2.22, Md=1 1 2.21, Md=1 1 LOW-END CONCENTRATION: % of individuals who do exactly 1 act/month % who do 1 or 2 acts/month 54% 75% 51% 73% 55% 75% 60% 75% HIGH-END CONC. Top 1/10th individuals account for: (%acts) 34% 46% 32% 34% OVERALL CONCENTRATION: (Gini) 0.42 0.51 0.42 0.43 Sociology, University of Edinburgh [1] Anal Intercourse to Ejaculation

25. Use & Development of Sexual Diaries in Project SIGMA • Largest • Most extensive (in time, location, age, etc) • Well-documented data set of sexual diaries • With associated special-purpose software • Enabling session-based, act-based or individual-based analysis Sociology, University of Edinburgh

26. 1,661 individuals from • 25 sites in the UK produced • 1,963 month-long diaries • consisting of • 32,142 sexual sessions Sociology, University of Edinburgh

27. ARCHIVING : SEXUAL DIARY DATA…… • Exist in two forms: • Natural-language (anonymised) originals • hard-copy diaries have been anonymised, indexed, documented and reduced to micro-fiche form; • now archived and lodged in Wellcome Contemporary Medical Archives Centre, London; • accessible to any bona fide researcher. • http://www.wellcome.ac.uk/en/library/homlib/HOMlibCOLspeCMCaccGENmtr.html#P Sociology, University of Edinburgh

28. ARCHIVING : SEXUAL DIARY DATA…… • Machine-readable (flat) database of diary records • SIGMA Panel members’ (and additional groups’) diary data in pre-database format (.dmp files) for entry into other database and special purpose analytic software; • To be lodged at Data Archive, Essex (http://dawww.essex.ac.uk/); • Plans for dissemination of these data, and wider SIGMA data in NESSTAR environment: • http://www.nesstar.org/ Sociology, University of Edinburgh

29. ARCHIVING : SEXUAL DIARY DATA…… • Cross-linking index • In preparation to enable original diary, machine readable version and interview data to be cross-accessed; • Special-purpose software • Written to store and analyse these data (SDA: Sexual Diary Analysis) • These data & programs also available from Data Archive / Project SIGMA Essex Sociology, University of Edinburgh

30. WEBSITE • Contains Documentation, Programs, Sample Data, Diary Form, Publications, Conference OHP’s: • http://www.sigmadiaries.com/ Sociology, University of Edinburgh

31. CONCLUSIONS • Sexual Diaries….. • At the humblest level, offer a markedly different, non-reactive contrast to SAQ/interview data on sexual behaviour • data are more like a “trace” than an account; the significant data are “read-off” the sexual accounts, not estimated by the respondent • relate both acts and individuals and allow their integration ( e.g. concentration) Sociology, University of Edinburgh

32. CONCLUSIONS • Sexual Diaries….. • can be interpreted not only as scripts, but linguistically as a simple code (language) and as free text, thus making semantic and grammatical analysis possible ( e.g. KWIC, co-occurr) • allow development and definition of higher-level categories (risk; “oriented risk”, power session...) • allow definition of rules, patterns sequences of any complexity, which can be defined, retrieved, & tested Sociology, University of Edinburgh

33. WEBSITE • Contains Documentation, Programs, Sample Data, Diary Form, Publications, Conference OHP’s: • http://www.sigmadiaries.com/ Sociology, University of Edinburgh