Safe sexual behaviors

Safe sexual behaviors in this study were assessed using the Safe Sex Behavior Questionnaire (SSBQ) developed by DiIorio et al. [27]. This 24-item tool was designed to measure the frequency with which recommended practices were used to reduce the risk of exposure to and transmission of sexually transmitted infections. It contains 15 positive and nine negative items across five sub-factors: risky behaviors, assertiveness, condom use, avoidance of bodily fluids, and avoidance of anal sex. Each item is rated on a 4-point scale from 1 (never) to 4 (always), and a higher total score (possible range, 24–96 points) indicates more frequent adoption of safe sexual behaviors. Cronbach’s α was .88 upon the tool’s development [27] and .80 in this study.