Validation of an Extended Sexual Orientation and Gender Identity Measure in a Racially and Ethnically Diverse Cohort of People Living with or at Risk for HIV Infection

Abstract Despite becoming a routine part of clinical care, collection of sexual orientation and gender identity (SOGI) is not standardized, and common measures might not reflect the full range of LGBTQ+ experiences. In this study, we tested a novel expanded SOGI measure that addresses these concerns in a racially and ethnically diverse HIV cohort study. Participants ( N = 885) were randomized to complete either a common SOGI measure with fewer SOGI choices or an expanded SOGI measure with more response options. We assessed the sensitivity, specificity, positive and negative predictive values, and area under the curve of the receiver operating characteristic, comparing the common and expanded SOGI measures against a single LGBTQ+ identity question serving as the reference standard. We conducted the DeLong test to evaluate differences in the area under the curve between the common and expanded measures. The expanded measure had a sensitivity of 98.5% and a specificity of 81.2% for identifying LGBTQ+ participants. The common measure had a sensitivity of 99.2% and a specificity of 83.3%. The DeLong test yielded no statistically significant difference between these measures. This pattern persisted across most demographic groups, except for Black or African American participants, and participants in middle adulthood (41–60 years). There was no difference in participant discomfort in answering the questions in each measure. Collecting accurate SOGI information is crucial given persistent HIV-related healthcare disparities in LGBTQ+ populations.