Risk Assessment Battery (RAB)

The RAB is a self-administered questionnaire designed for repeat administration with substance using populations. It was developed to provide a rapid (less than fifteen minutes) and confidential, non-interview method of assessing both drug use practices and sexual behaviors associated with HIV transmission. The RAB provides a measure of HIV risk behaviors, which is broken down into sub-scales for drug risk and sex risk and combined to yield a measure of total risk.

The 45 questions of the RAB are simply worded and use discrete response categories. Respondents are asked to "check-off" the answer that best describes their behavior. There are no open-ended questions, minimizing the need for writing skills. A brief set of instructions is included on the first page of the RAB. However, as with all self-administered questionnaires, it is particularly important to provide the respondent with a proper introduction and explanation of the form, its purpose, and how it is to be completed. Given the very sensitive nature of the information collected, it is also important that individuals administering the RAB address the issue of confidentiality. While the more private approach of the self-administered questionnaire should reinforce the confidential nature of the assessment, it is very important that respondents understand that the confidentiality of their responses will be protected.

A staff member should be available during administration of the RAB to screen for reading difficulties, answer questions as they arise and ensure that the items are being attended to properly.

There are two global sections within the RAB: 1) drug and alcohol use during the past 30 days, and 2) syringe use and sexual behavior during the previous six months. Questions have been constructed to provide maximum coverage and sensitivity to potential risk behaviors within these categories. Since self-report may be expected to provide underestimates of behaviors that are socially unacceptable, we have assembled items that assess a wider range of behaviors associated with HIV infection. Thus, questions ask not only about the behaviors directly responsible for viral transmission such as syringe sharing and unprotected sexual activity, but also associated with these activities (e.g. syringe acquisition, shooting gallery attendance, exchange of money or drugs for sex). The inclusion of these items is intended to identify individuals at increased risk of HIV exposure, even if transmission behaviors are not directly reported. However, affirmation of these "peripheral behaviors" does not prove that transmission behaviors have actually occurred. For example, an individual who has visited a shooting gallery on numerous occasions during the assessment interval may not have shared a needle or had unprotected sex, even though these behaviors are common in shooting galleries. However, these peripheral behaviors may be more readily reported by some respondents despite their reluctance to report primary transmission events such as sharing a syringe or unprotected sexual activity.

As a self-administered questionnaire, the RAB offers an efficient tool for screening individuals who may be at risk for HIV infection. Further, it provides a means to target and evaluate interventions in a more precise manner.

Seventeen items from the RAB are used in the computation of three scores - a drug-risk score, a sex-risk score, and a total score. These scores are calculated by adding responses to selected items. For individual questions, the response values range from 0 to a maximum of 4. Higher values for items reflect greater frequency of occurrence of the behavior. The eight item drug-risk score has a range of 0 to 22. The range of the sex-risk score, comprised of 9 items, is 0 to 18. This simple scoring system was designed to capture frequency of engaging in each of the reported risk behaviors. Scores for the various items are not differentially weighted. This scoring strategy serves to guard against underestimates of risk resulting from the tendency to under-report participation in behaviors known to be most likely to transmit the HIV virus.

Studies conducted by the authors and others suggest that when properly administered, the RAB responses are equivalent to those collected via personal interview. Test-retest reliability has also been found to be relatively high. Importantly, the RAB has demonstrated discriminant validity in differentiating between respondents engaging in different drug use patterns and predictive validity in identifying seroconverters on the basis of higher risk scores.

Internal consistency

  • Drug risk score: Cronbach alpha = .82
  • Sex risk score: Cronbach alpha = .42

Factor/cluster analysis

  • Factor structure was examined in developing drug and sex risk scales



Population Drug Risk Sex Risk
Methadone .80 .69
Cocaine .73 .88

Inter-method Comparison: NIDA AIDS Follow-up Assessment [AFA] and RAB

Item % Reporting on RAB % Reporting on AFA Exact Agreement Phi Kappa
Drug Risk          
Injected 62.7 63.5 96.5 .93 .93
Shared Syringes 18.9 16.9 94.5 .81 .81
Shared w/ Multiple IDUs 4.7 4.5 96.6 .61 .61
Shared Cotton 30.6 25.1 88.9 .76 .75
Shared Cooker 34.1 33.6 92.7 .84 .84
Shared Rinse Water 28.1 24.4 88.5 .70 .70
Sex Risk          
Sex w/ Multiple Partners 24.5 24.3 96.6 .91 .91
Always Use Condoms 28.9 20.4 85.8 .64 .62

Construct Validity

  • Significantly higher drug risk scores for methadone program patients as compared to cocaine users in treatment
  • Significantly higher sex risk scores for cocaine users as compared to IDUs

Predictive Validity

  • Compared risk scores of IDUs who seroconverted at any time point with IDUs who remained seronegative; by follow-up month (M)

IDUs Who Remained Seronegative by Follow-up Month

RAB Seroconverted 12M 18M 24M 30M 36M 42M 48M
Risk Score n=17 n=137 n=140 n=139 n=137 n=135 n=137 n=142
Drug Risk 5.75 3.31* 2.66* 2.27* 1.99* 2.27* 2.23* 1.84*
Sex Risk 5.18 4.18 4.05 3.67 3.60 3.31* 3.34* 3.13*
RAB Total 10.94 7.59* 6.74* 5.96* 5.64* 5.61* 5.59* 4.59**

* p<.05; **p<.005

To download a printable version of the Risk Assessment Battery (RAB) or the RAB Scoring System, please click on a link below:

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