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Interpartner Reliability of Reporting of Recent Sexual Behaviors
Abstract
Epidemiologic studies exploring risks for sexually transmitted diseases, including human immunodeficiency virus infection, typically rely on self-report of sexual behaviors. Estimates of the incidence and prevalence of sexual practices are important measures for assessment of behavioral interventions as well as for examining disease transmission. This study examined the degree of agreement within heterosexual couples reporting frequency and type of sexual behaviors, including condom use. Self-reports were obtained from 71 couples attending Baltimore sexually transmitted disease clinics in 1989-1990 regarding the number of days and number of episodes of three specific sexual practices (any type of sexual activity, vaginal sex, and vaginal sex with condom use) over a 30-day period. Paired t test analysis revealed both sexes to be very consistent in their reporting of recent sexual experiences. Multivariate analysis showed that agreement did not vary by socioeconomic status, by whether the partners were married to each other, or by age. These findings suggest that reliable information regarding sexual behaviors may be obtained from men or women.
... Research findings on the level of concordance on shared sexual behaviors and condom use are mixed but, overall, they demonstrate fair to good inter-partner agreement [1,5,[8][9][10][11][12][13][14][15] Identifying specific respondent factors predicting partners differing on sexual reports may contribute to improving couple assessment by anticipating such discrepancies and developing effective mechanisms of quality assurance to avoid, address, or better explain such discordance in couple data sets. ...
... The findings in the literature on individual and relationship predictors on shared sexual behaviors and condom use are also mixed. Several studies found partner agreement on sexual behaviors and risks (condom use, number of sexual partners, commercial sex) did not vary by age, ethnicity, or infection status and relationship factors (duration of relationship, quality of relationship) [14,16], whereas others found associations between shared sexual behaviors and demographic variables [3,12], and between shared sexual behaviors and relationship characteristics [3]. Moreover, a study by Witte et al. (2007) [3] found that among couples where the male partner was HIV positive, there was higher discordant reporting on whether the couple used condoms compared to those in which the men were HIV negative. ...
... Couples' reports on having had anal and oral sex in the past 90 days (both reported 'yes,' both 'no,' and discordant), show moderate to high concordance as measured by the Kappa index, which is consistent with most previous studies [2,3,10,12,14,25]. However, Kappa for reporting vaginal sex indicates poor agreement (because Kappa values can be misleadingly low when the prevalence of the responses is skewed, as is the case with reports of vaginal sex). ...
This paper examines the concordance of reported shared sexual behaviors, including condom use, among 535 heterosexual, African American, serodiscordant couples and identifies factors that might predict discordant reports. Percentages of agreement, Kappa and McNemar’s statistics and conditional probability indices are used to measure concordance. Logistic regression models identify predictors of couples’ discordant sexual reports. Analyses revealed Kappa statistics for reporting anal sex, fellatio and cunnilingus indicated moderate to substantial agreement. The effects of demographics and the couples’ relationship contexts on concordance of reported sexual behaviors were found to vary somewhat by gender and type of sexual behavior. Findings showed that concordance of reporting between the couples was consistent for the past 90 and 30 days. Findings from this paper provide new scientific insights into the knowledge base of self-reported couples’ data and suggest that these data can be used to evaluate their accuracy and serve as a proxy for validity.
... Just such a sample was obtained for the ACSF survey, in which initial questioning of a large number (20,055, of which 8,951 men) made it possible to construct a manageably sized sub-sample of individuals who were then questioned in greater depth. Among others, this sub-sample included all the individuals who reported having had sexual intercourse with partners of the same sex during the last five years [31]. Individuals who had had homosexual relations more than five years ago were also included if they satisfied one other criterion of the 'filter card' (for details see the section 'Method' below) and thus in a less systematic way. ...
... The methodology employed to establish the sample for the ACSF survey has been described elsewhere [2] [31], so here we shall merely reiterate its main characteristics and consider the influence it may have had on the selection of a sub-sample of male homo-bisexuals. ...
... For example, while the higher socio-professional position and educational level of homosexuals [13] [19] [20] [21] tends to favour access to and greater use of the telephone, a stronger desire for anonymity may increase the likelihood of having ex-directory status. Similarly, their higher number of sexual partners [9] [12] [31] and the absences from home it implies could make male homo-bisexuals harder to contact by telephone; yet at the same time the telephone may be an indispensable instrument in organizing such multiple partner relationships, thus requiring the individual to be easily reached. Only a study of the type of sexual activity according to the difficulty of telephone contact, data that is available in the ACSF survey, can shed light on these problems and on the distortions of the survey (see the article by Jean-Marie Firdion in the present volume). ...
... Several studies have evaluated the accuracy of the information that individuals provide about the sexual behaviours or STI statuses of their sex partners [2,3,[7][8][9][10][11][12][13][14][15][16][17][18][19][20]. These studies examined the level of agreement between two types of behaviours. ...
... Some studies assessed behaviours and risk factors that were shared by a couple (e.g. frequency of having sex together, condom use) and reported good agreement between partners [3,9,10,[16][17][18][19][20]. Other studies assessed behaviours and risk factors that a couple did not necessarily share (e.g. ...
Background
Swingers are members of a heterosexual couple who, as a couple, have sex with others. They constitute a hidden subpopulation that is at risk for sexually transmitted infections (STIs). This study aimed to determine swingers’ level of awareness about the STI risk (indicators: bisexual behaviour, number of sex partners, and STI status) of their swing sex partners (i.e. alters ).
Methods
In this cross-sectional study, data were collected from a convenience sample of swingers who visited our STI clinic. The sample consisted of 70 participants (i.e. egos ) and their 299 swing sex partners (i.e. alters) who had undergone an STI test at our clinic. We compared network data (i.e. information that egos provided about alters) and data stored in the electronic patient record (EPR) in our clinic (i.e. information provided by alters themselves). We assessed the agreement (correct estimation, overestimation and underestimation) between the network data and EPR data using chi-squared tests.
Results
Egos underestimated the bisexual behaviours of 37% of their male alters and overestimated the number of sex partners of 54 and 68% of their male and female alters, respectively. Egos correctly estimated the STI statuses of only 22% of the alters who had an STI during the past six months.
Conclusions
The participating swingers underestimated the bisexual behaviours of their male swing sex partners, overestimated their number of sex partners, and underestimated their positive STI status. Underestimating their alters’ STI statuses can cause swingers to underestimate their own STI risk and fail to implement preventive measures. The latter finding has implications for STI prevention. Therefore, more attention should be paid to swingers in general and the promotion of actual partner notification and STI testing among swingers in specific.
... However , Brewer, Rothenberg, Muth, Roberts, and Potterat (2006) did not identify significant associations between dyadic concordance on reported dates of joint sexual activity and age/age difference, marital status, socioeconomic status, race/ethnicity in a sample of heterosexual couples. Similarly, Upchurch et al. (1991) did not identify any dyadic correlates of interpartner agreement in a sample of heterosexual couples. ...
... However, we are aware of only a handful of dyad-GBMSM reliability studies (Carballo-Diéguez et al., 1999;Coates et al., 1988) and only one recent study that has examined predictors of interpartner agreement of reported HIV risk behaviors in this population (Hernández-Romieu et al., 2016). Additionally, we are aware of only a single study that quantified or analyzed the difference between partner reports of sexual behavior frequencies (in a heterosexual sample) (Upchurch et al., 1991). This leaves a significant gap in our understanding of the reliability, and its related factors, of HIV-risk behavior data in GBMSM. ...
Coupled gay, bisexual, and other men who have sex with men (GBMSM) are at particularly high risk for HIV, and a clear understanding of behavioral risk is key to effective interventions. Accurate behavioral self-reports are a crucial component of valid sexual health research, yet reliability of these data remains understudied. This study aimed to quantify and identify predictors of dyadic discordance in reported 3-month anal intercourse (AI) occurrence and frequency. Using cross-sectional data from 407 male couples in the U.S. (2016–2017), we calculated proportional dyadic concordance and used dyad-level logistic and linear regression to identify demographic, behavioral, and relationship traits associated with the odds of discordant frequency reports and the relative difference between discordant partner reports. Couples had high levels of concordant reports of 3-month anal AI occurrence (97%) but low interpartner agreement in reported frequency (37%). After adjustment, the odds of discordance were significantly associated with dyadic employment and differences on the Communal Coping to Reduce HIV Threat Scale (CCS) (p < .05). Among frequency-discordant couples, the mean relative difference between partner reports was 52.80% ± 35.91% (M ± SD). After adjustment, relative differences between partners’ reported AI frequencies were positively associated with interpartner differences in CCS (p < .05). These results indicate that among GBMSM couples in committed partnerships, self-reported sexual behavior data may be impacted by granularity, recall, and relationship characteristics. Further research in this area is warranted to better understand measurement error in self-reported sexual activity data.
... Assessing the quality of sexual intercourse dates is important for establishing margins of error, identifying factors associated with greater reporting error, and suggesting interventions to improve accuracy. Although studies have assessed the quality of many facets of sexual partnership data--2,10-17 such as number of sex partners, 11,12 which sex acts occurred, 10,17,18 age of first intercourse, 12 frequency of sex, 12,13,16,18,19 and condom use-- 2,16,19 research on the quality of sexual partnership dates 16,20,21 is limited. ...
... Assessing the quality of sexual intercourse dates is important for establishing margins of error, identifying factors associated with greater reporting error, and suggesting interventions to improve accuracy. Although studies have assessed the quality of many facets of sexual partnership data--2,10-17 such as number of sex partners, 11,12 which sex acts occurred, 10,17,18 age of first intercourse, 12 frequency of sex, 12,13,16,18,19 and condom use-- 2,16,19 research on the quality of sexual partnership dates 16,20,21 is limited. ...
Background:
Sexual partnership dates are critical to sexually transmitted infection/HIV research and control programs, although validity is limited by inaccurate recall and reporting.
Methods:
We examined data from 302 heterosexual adults (151 index-partner dyads) to assess reliability of reporting. Dates of first sex and last sex were collected through individual interviews and joint dyad questionnaires, which were completed together with their partners. We compared index- and partner-reported dates to estimate interpartner agreement. We used log-linear regression to model associations between interpartner differences and partnership characteristics. To assess validity, we compared individually reported dates with those from joint dyad questionnaires.
Results:
Most partnerships (66.2%) were 2 years or less in duration, and many (36.2%) were nonmonogamous. Interpartner agreement to within 1, 30, and 365 days was, respectively, 5.6%, 43.1%, and 81.3% for first sex, and 32.9%, 94.5%, and 100.0% for last sex. In adjusted models, longer relationship duration was associated with disagreement on first sex dates; partnership nonmonogamy was associated with disagreement on dates of first sex and last sex. Within dyads, several participant characteristics were associated with reporting dates closer to joint dyad responses (e.g., for first sex date, female sex [54.7%], having fewer sex partners [58.5%], and greater relationship commitment [57.3%]). However, percent agreement to within 30, 60, and 90 days was similar for all groups for both first and last sex dates.
Conclusions:
Agreement was high on date of last sex but only moderate on date of first sex. Methods to increase accuracy of reporting of dates of sex may improve STI research.
... Four were conducted among heterosexual couples [84][85][86][87] and one, among gay men [88]. ...
... Two studies found that women reported more sexual activity than their male partners [84,85]. Greater differences between partners' reports were consistently found as the reporting period grew more distant past (e.g., 4 weeks ago, as compared to 1 week ago) [84,86,88] months between partners' self reports [85], although another study reported only 26% agreement [87]. ...
... There is a strong association between relationship status and the type of contraceptive method used, although the direction and magnitude of the effect has been mixed. Some studies have found that relationships that are new or casual are more likely to use condoms and to do so consistently, while relationships that are established or steady are less likely to include condom use and more likely to include hormonal methods (Catania et al., 1989; Cooper et al., 1998; Fortenberry et al., 2002; Katz et al., 2000; Ku, Sonenstein, & Pleck, 1994; Macaluso, Demand, Artz, & Hook, 2000; Seidman, Mosher, & Aral, 1992; Sheeran, Abraham, & Orbell, 1999; Upchurch et al., 1991; Wingood & DiClemente, 1998). Another set of studies finds the alternative; contraceptive use is more common in committed than in casual relationships (Abma, Driscoll, & Moore, 1998; Ford & Norris, 2000; Ford, Sohn, & Lepkowski, 2001; Manlove, Ryan, & Franzetta, 2003; Manning, Longmore, & Giordano, 2000; Norris, Ford, Shyr, & Schork, 1996). ...
... Not only are the characteristics of the individuals forming the relationship of importance in determining contraceptive practices, but so too are the unique features of the relationship itself. Like other studies, we find that the nature and characteristics of relationships influence contraceptive behavior (Ford & Norris, 2000; Ford et al., 2001; Howard et al., 1999; Katz et al., 2000; Ku et al., 1994; Manning et al., 2000; Manlove et al., 2003; Sheeran et al., 1999; Upchurch et al., 1991; Wingood & DiClemente, 1998). We have, however, gone beyond the scope of other studies by incorporating individual's multiple relationships from mid-adolescence to young adulthood and by utilizing multilevel techniques to examine these relationships. ...
Contraceptive behavior by an individual varies both across and within relationships, and the nature and characteristics of relationships can influence use and the type of method used. This study utilizes the retrospective sexual relationship histories of young adults available in the most recent wave (2001-2002) of the National Longitudinal Study of Adolescent Health (Add Health) to explore relationship-specific contraceptive method choice. Hierarchical generalized linear modeling is used to estimate the effects of both relationship-level and individual-level characteristics on the type of contraceptive method used at last sex. Four mutually exclusive categories for method use were constructed: condom only, hormonal method only, dual method (condom plus hormonal method), and no method. A number of relationship characteristics are significantly associated with contraceptive use even when controlling for individual characteristics. Moreover, the effects of relationship characteristics differ depending on the type of method examined. Significant between-individual variation in the type of contraceptive method used remains. Not only are the characteristics of the individuals forming the relationships of importance in determining contraceptive practices, but so too are the unique features of the relationship itself. Further investigation of other aspects of the relational context is warranted.
... A growing body of literature suggests that contraceptive behavior may indeed vary by the characteristics of youths' partners and relationships (Ford, Sohn, & Lepkowski 2001; Howard et al. 1999; Katz et al. 2000; Ku, Sonenstein, & Pleck 1994; Manlove, Ryan, & Franzetta 2007; Manning, Longmore, & Giordano 2000; Soler et al. 2000; Upchurch et al. 1991; Wingood & DiClemente 1998), and highlights two salient dimensions: relationship commitment and couple heterogamy. ...
... This distinction is found to explain some variation in contraceptive practices, although the direction and magnitude of this association has been mixed. Most studies indicate that new or casual relationships are more likely to use condoms and to do so consistently, while established or serious relationships are less likely to include condoms and more likely to include hormonal methods yet not necessarily consistently (Fortenberry et al. 2002; Katz et al. 2000; Ku et al. 1994; Macaluso et al. 2000; Ott et al. 2002; Upchurch et al. 1991). But, some studies also find that any contraceptive use is more common in committed relationships (Ford et al. 2001; Manlove et al. 2007; Manning et al. 2000). ...
We examine the relationship characteristics associated with contraceptive method choice within young people's nonmarital sexual relationships, using data from retrospective relationship histories available in the third wave (2001-2002) of the National Longitudinal Study of Adolescent Health. Data-reduction techniques produce a detailed multidimensional characterization of relationship commitment for nonmarital sexual relationships. We then use multilevel analysis to estimate associations between two key relationship characteristics-relationship commitment and couple heterogamy-and the type of contraceptive method used at last sexual intercourse within each relationship. Results indicate that for a given individual, contraceptive method choice varies across relationships as a function of these characteristics, even after we account for important individual and family characteristics and prior relationship experiences.
... These may not be perfectly accurate, as subjects may not remember their sexual activity accurately or may be reluctant to disclose their sexual behaviour. However, prior studies confirm that this kind of self-reports yield reasonably reliable results-for example, partners' retrospective reports of marital intercourse frequency are consistent (Clark & Wallin, 1964;Upchurch et al., 1991). Also, it is possible that sex drive is decoupled from the actual sexual behaviour (e.g., not engaging in sexual behaviour despite high desire to do so, or having sex without experiencing desire), yet on average the frequency of sexual behaviours is concordant with the sexual drive (Santtila et al., 2007). ...
The endogenous mu-opioid receptor (MOR) system modulates a multitude of social and reward-related functions, and exogenous opiates also influence sex drive in humans and animals. Sex drive shows substantial variation across humans, and it is possible that individual differences in MOR availability underlie interindividual of variation in human sex drive. We measured healthy male subjects’ ( n = 52) brain’s MOR availability with positron emission tomography (PET) using an agonist radioligand, [ ¹¹ C]carfentanil, that has high affinity for MORs. Sex drive was measured using self-reports of engaging in sexual behaviour (sex with partner and masturbating). Bayesian hierarchical regression analysis revealed that sex drive was positively associated with MOR availability in cortical and subcortical areas, notably in caudate nucleus, hippocampus, and cingulate cortices. These results were replicated in full-volume GLM analysis. These widespread effects are in line with high spatial autocorrelation in MOR expression in human brain. Complementary voxel-based morphometry analysis ( n = 108) of anatomical MR images provided limited evidence for positive association between sex drive and cortical density in the midcingulate cortex. We conclude that endogenous MOR tone is associated with individual differences in sex drive in human males.
... These may not be perfectly accurate, as subjects may not remember their sexual activity accurately or may be reluctant to disclose their sexual behaviour. However, prior studies confirm that this kind of self-reports yield reasonably reliable results-for example, partners' retrospective reports of marital intercourse frequency are consistent (Clark & Wallin, 1964;Upchurch et al., 1991). Also, it is possible that sex drive is decoupled from the actual sexual behaviour (e.g., not engaging in sexual behaviour despite high desire to do so, or having sex without experiencing desire), yet on average the frequency of sexual behaviours is concordant with the sexual drive (Santtila et al., 2007). ...
The endogenous mu-opioid receptor (MOR) system modulates a multitude of social and reward-related functions, and exogenous opiates also influence sex drive in humans and animals. Sex drive shows substantial variation across humans, and it is possible that individual differences in MOR availability underlie interindividual of variation in human sex drive. Here we measured healthy male subjects’ ( n =52) brain’s MOR availability with positron emission tomography (PET) using an agonist radioligand, [ ¹¹ C]carfentanil, that has high affinity for MORs. Sex drive was measured using self-reports of engaging in sexual behaviour (sex with partner and masturbating). Bayesian hierarchical regression analysis revealed that sex drive was positively associated with MOR availability in cortical and subcortical areas, notably in caudate nucleus, hippocampus, and cingulate cortices. These results were replicated in full-volume GLM analysis. These widespread effects are in line with high spatial autocorrelation in MOR expression in human brain. Complementary voxel-based morphometry analysis ( n =108) provided limited evidence for association between sex drive and cortical density in the midcingulate cortex. We conclude that endogenous MOR tone is associated with individual differences in sex drive in human males.
... Validity and reliability of the selfreports are questioned as responses tend to be influenced by embarrassment, social desirability and recall bias (Bell, Montoya, & Atkinson, 2000;Bogart et al., 2007;Ellish, Weisman, Celentano, & Zenilman, 1996;Enel, Lagarde, & Pison, 1994;Lagarde, Enel, & Pison, 1995) while certain socially unacceptable behaviors, like sex work, homo-or bisexuality, adultery and premarital sex may be concealed (Glynn, Caraël, & Auvert et al., 2001). However, carefully designed interviews can elicit reliable sexual histories in some conservative populations (Padian, Aral, Vranzian, & Bolan, 1995;Upchurch, Weisman, & Shepherd et al., 1991). ...
Reliability of self-reported sexual and safe sex behavior among heterosexual HIV discordant couples was assessed by matching individual responses of couples to a common set of questions and validated by matching with pregnancy and seroconversion during study period. Demographic, clinical and sexual behavior information was collected individually from 457 consenting married discordant couples using structured questionnaires at screening, enrollment and at four quarterly visits. Reliability of self-reports tested using Kappa statistics. At screening, level of agreement about spouse being regular partner (Kappa = 0.96) and having had sexual intercourse with spouse in the last quarter (Kappa = 0.84) was noted. Moderate agreement observed about frequency of condom use (Kappa = 0.639) and condom tear (Kappa = 0.428). Agreement on reporting sexual contacts with spouse and consistent condom use increased (P < 0.001) over follow-ups. Four of 6 couples that seroconverted reported using condoms consistently, and 2 of these seroconverted. Couple histories of all 11 sero-discordant couples reporting pregnancy matched, of these 8 couples reported use of condoms and only 3 couples reported non-use of condoms during the preceding period. Sensitive sexual information can be collected using self-reports but it should be used with caution. Involving couples and using biological parameters concurrently may enhance validity of self-reports.
... There have been several studies done on the reliability and validity of self-reported sexual behaviour. James et al. (James et al., 1991) found that the information obtained from self-administered questionnaires and face-to-face interviews was largely consistent, as were data collected by Upchurch (Upchurch, 1991) from couples attending STD clinics. However, both these studies were carried out in developed countries. ...
... Several studies have examined this issue by assessing interpartner concordance as a marker of condom self-report validity. These studies have found that independent partner agreement is high for reports of vaginal sex, anal sex, and condom frequency [59][60][61][62] and this is true specifically among African American couples [63]. Despite this, clinic records or biological endpoints would strengthen these findings. ...
The aim of this study was to develop and test a cost-effective, scalable HIV behavioral intervention for African American women. Eighty-three African American women were recruited from a community health center and randomly assigned to either the web-based Safe Sistah program or to a delayed HIV education control condition. The primary outcome was self-reported condom use. Secondary measures assessed other aspects of the gender-focused training included in Safe Sistah. Participants completed self-report assessments prior to randomization, 1- and 4-months after their program experience. Across the entire study period, women in the experimental condition significantly increased their condom use relative to controls (F = 5.126, p = 0.027). Significant effects were also found for sexual communication, sex refusal, condom use after alcohol consumption, and HIV prevention knowledge. These findings indicate that this web-based program could be an important component in reducing the HIV disparities among African American women.
... 1995;~atania, Coates, et al., 1993 andCantania, et al., 1992;CDC, 1998;Choi, et al., 1994;Dolcini, et al., 1993;Ehrhardt, 1992;Ehrhardt, et al., 1991;Feinleib and Michael, 1998;Grady, et al., 1993;Laumann, Gagnon, Michael, and Michaels, 1994;Leigh, et a1 . , 1993 andMosher and Pratt, 1993 ;Rogers and Turner, 1991;Seidman and Rieder, 1994;Smith, 1991a andSonenstein, Pleck, et al., 1989, 1991Spira et al., 1994) and methodological studies of measurement error associated with these studies (~nsuini, et al., 1996;Auster, n-d.;Biggar and Melbye, 1992;Binson and Cantania, 1998;Boekeloo, et al., 1994;Brody, 1995;Brown, 1996;Cantania, 1996;Cantania, Binson, Canchola, et al., 1996;Catania, et al., 1995;Cantania, Gibson, et al., 1990;Catania, McDermott, et al., 1986;Cantania, Turner, et al., 1993;Cecil, 1998;Clark, et al., 1997;Clayton, et al., 1997;Downey, et al.;Dunne, et al.;Edelman, 1998;Ellen, et al., 1998;Ellish, et al., 1996;Giami, 1996;Hornsby and Wilcox, 1989;Huygens, et al., 1996;Jaccard, et al., 1998;James, 1998;Kanouse, et al., 1991;Karabatsos, 1997;Kissinger, et al., 1999;Kupek, 1998;Latkin and Vlahov, 1998;Lauritsen and Swiceqood, 1997;Leyland, et al., 1992;Maass and Volpato, 1989;~etzler, et al. ;1992;Miller, 1995 andMorris, 1993;Newcomber and Udry, n-d.;Orr, et al., 1997;Padian, et al., 1995;Peterman, 1995;Poppen and Reisen, 1997;Risenthal, et al., 1996;Seal, 1997;Shew, et al., 1997;Smith, 1992a, 1992bSmith, 1996 andTrivedi and Sabini, 1998;Turner, et al., 1998;Upchurch, et al., 1991;Van Duyhoven, et al., 1999;Wadsworth, et al., 1996;Weinhardt, Forsyth, et al., 1998;Wiederman, 1997;Zenilman, et al., 1995;Zimmerman and Langer, 1995). ...
... Questions similar to the ones we propose have been asked previously in couples' surveys in the US (e.g., [58]) and in sub-Saharan settings [53,59,60]. They have however only been used to investigate whether individuals are aware of their partners' sexual networks [58,61] or assess whether partners agree on reports of couple-level risk behaviors, e.g., date of last sex or condom use [53,59,62,63]. They have not been used to improve the measurement of CPs and inferences about the effects of CPs on HIV outcomes. ...
Empirical estimates of the association between concurrent partnerships (CP) and HIV risk are affected by non-sampling errors in survey data on CPs, e.g., because respondents misreport the extent of their CPs. We propose a new approach to measuring CPs in couples, which permits assessing how respondent errors affect estimates of the association between CPs and HIV risk. Each couple member is asked (1) to report whether s/he has engaged in CPs and (2) to assess whether his/her partner has engaged in CPs, since their couple started. Cross-tabulating these data yields multiple classifications (with varying combinations of sensitivity/specificity) of the CPs of each couple member. We then measure the association between CPs and HIV outcomes according to each classification. The resulting range of estimates is an indicator of the uncertainty associated with respondent errors. We tested this approach using data on 520 matched couples drawn from the Likoma Network Study. Results suggest that existing tests of the concurrency hypothesis are affected by significant uncertainty.
... However, studies done on the reliability and validity of self-reported sexual behavior found that information obtained from self-administered questionnaires and face-to-face interviews was largely consistent from couples attending STI clinics. (Walden et al., 1999;James et al., 1991;Upchurch, 1991). ...
HIV/AIDS interventions are currently being designed and carried out in the developing world. Some of these interventions are evaluated by randomized controlled trials, with accompanying cost analyses, and others are evaluated with small cross-sectional surveys. The process of designing and evaluating
... Furthermore, we observed that protection is most likely to take place in occasional relationships marked by a high social heterogamy [33], occasional partners being more often encountered in what is a secondary zone compared with the primary area of socialization [36]. Differences in condom use according to type of partner have been found in other research [27,38,41,50,54]. A strong link between not knowing a partner and protective behaviour is also indicated by other data. ...
In contrast with the psychologically based individualistic models of health behaviour in which conduct adopted in response to AIDS risk is seen as an individual decision depending on the processing of information, we postulate that individuals construct their own definition of the risk of HIV transmission by drawing on their socio-sexual lifecourse and the type of sexual relationships in which they are engaged. Data were obtained from a random sample of 4820 people living in France interviewed by telephone between September 1991 and February 1992. This analysis was conducted on a subgroup of 1508 men and 1376 women in sexual relationships of less than five years. Multiple correspondence analysis and logistic regression were performed. Our findings show that the adoption of preventive behaviour is far from depending exclusively on the awareness of risk. Individuals having a diversified sexual experience, who talked about sexuality during their childhood and have personal confidants more often reported having changed their sexual behaviour because of AIDS. Although less likely to select their partner in order to reduce the risk of AIDS, they more often adopt strategies directly linked to sexual interaction such as condom use. Individuals belonging to networks in which condom use is the norm are more likely to use them. Women, for whom stable relationships propitious to the development of emotional closeness carry a high social value, are more likely to rely on uniquely relational strategies in which the adaptation to the risk of infection involves a better knowledge of the partner. Our findings reveal that individuals attach a different degree of risk to their partners depending on whether they occupy a central or peripheral place in their network of sociability. Furthermore, we observed an incompability between the preventive and the socio-affective rationale in which condom use is inversely related to the degree of intimacy, regardless of what is known about the partner's serological status. Risk adaptation strategies are thus far from being irrational, but are related to individuals' socio-sexual biography, the logics of gender, social networks and milieux of sociability, and depend ultimately on the context of the relationship. As with other health-related behaviour, coping strategies appear to be the product of a complex interaction of biographical, social and cultural threads. Prevention campaigns based exclusively on the promotion of individual responsibility are thus likely to miss the mark.
... Although concordance on these measures may indicate data accuracy, research also suggests that partners often have misconceptions of their partners' attitudes toward condom use, sexual responsibility, sexual decision-making power, and substance use (Harvey et al., 2004;Seal, 1997;Witte et al. 2007). In addition, in some instances, concordance has been found to vary by individual characteristics such as age, ethnicity, and level of relationship satisfaction (Seal, 1997;Upchurch et al., 1991;Witte et al., 2007). Examination of concordance and discordance between couple members may help to tease out circumstances where data accuracy is in question or potentially elucidate circumstances where important individual-or couple-level dynamics are at play. ...
Research on couples' sexual behaviors is limited because most studies collect data from only one person, rely on retrospective recall, and lack ecological validity. This study explored the feasibility of using momentary sampling (MS) methods to collect sex event data from both members of heterosexual young adult couples. Over two weeks, 40 participants (20 couples) were asked to use a handheld computer to respond to random auditory signals each day and self-initiate a report as soon as possible after sex. Couples were randomized into two groups: (a) both partners reported after sex events, or (b) one partner reported after sex events during Week 1 and the other during Week 2 (randomized by gender). Descriptive statistics examined protocol compliance, partner agreement on whether an event occurred, condom use, and reason for sex, as well as partner involvement in reporting, comfort with reporting after sex, and study burden. Results indicated that couples were willing and able to adhere to the protocol. Partners agreed on condom use for nearly all sex events, but frequently reported different reasons for sex events. The use of MS methods to collect information about sex events within couples is a promising approach to the study of sexual behavior.
... Finally, data was collected using self-administered questionnaires, which may have influenced the reliability. Though, several studies among drug users have underscored the trustworthiness of selfreported data, in particular on MSM and other sexual behaviour (Rotily et al., 2001; Upchurch et al., 1991; Weinhardt et al., 1998), and most have shown that drug use self-reporting is generally reliable (McElrath et al., 1994; Rotily et al., 2001). In conclusion, while in our study no prisoners were tested HIV seropositive, the prevalences of HBV and HCV infections among these Dutch male prisoners were up to twenty times higher than in the general population. ...
International studies show high prevalences of blood-borne infections in prisoners but little is known about infectious diseases in Dutch prisoners. This study assessed the prevalence of HIV, hepatitis B and hepatitis C virus infections in Dutch prisoners and contributing risk factors. A cross-sectional serosurvey was conducted among male prisoners, using blood samples and questionnaires. Overall, 229 prisoners participated (77%). No prisoner was HIV seropositive. Nineteen prisoners (8.3%) were anti-hepatitis B core (anti-HBc) positive, three of whom were hepatitis B surface antigen (HBsAg) positive. Fifty (22%) were anti-HBs positive, either after vaccination or previous infection. The prevalence of antibodies to Hepatitis C virus (HCV) was 7.4%, of whom 4.8% was HCV-RNA positive. Over half of the prisoners reported drug use, 36% reported drug use in prison. The predictor for HBV was IDU (p<0.001); the predictors for HCV were higher age and injecting drug users (IDU) (p<0.05). Prevalences among injecting drug users (IDUs) were significantly higher than among non-IDUs (p<0.001). While we did not identify any HIV infected prisoners, the study showed that seroprevalences of Hepatitis B virus (HBV) and HCV infections among Dutch prisoners were up to twenty times higher than estimated for the Dutch general population. IDU was the most commonly reported route of transmission. Since only a minority of prisoners was immune to HBV, vaccination coverage in prisoners should be enhanced.
... For example, Harrington et al 37 found that the reliance on selfreports of STD history produced substantial underreporting of STD incidence and thereby may lead to false conclusions with respect to the effects of prevention interventions. Although studies suggest that self-reported measures of sexual behaviors, such as condom use, tend to be reliable, 38 future studies should use biological measures. Another limitation may be that an attention control condition was not used in this study. ...
To determine the efficacy of a family intervention in reducing human immunodeficiency virus (HIV) risk behaviors among Hispanic delinquent adolescents.
Randomized controlled trial.
Miami-Dade County Public School System and Miami-Dade County's Department of Juvenile Services, Florida.
A total of 242 Hispanic delinquent youth aged 12 to 17 years and their primary caregivers completed outcome assessments at baseline and 3 months after intervention.
Participants were randomized to either Familias Unidas (120 participants), a Hispanic-specific, family intervention designed to reduce HIV risk behaviors among Hispanic youth, or a community practice control condition (122 participants).
Self-reported measures included unprotected sexual behavior, engaging in sex while under the influence of alcohol and/or drugs, number of sexual partners, and incidence of sexually transmitted diseases. Family functioning (eg, parent-adolescent communication, positive parenting, and parental monitoring) was also assessed via self-report measures.
Compared with community practice, Familias Unidas was efficacious in increasing condom use during vaginal and anal sex during the past 90 days, reducing the number of days adolescents were under the influence of drugs or alcohol and had sex without a condom, reducing sexual partners, and preventing unprotected anal sex at the last sexual intercourse. Familias Unidas was also efficacious, relative to community practice, in increasing family functioning and most notably in increasing parent-adolescent communication and positive parenting.
These results suggest that culturally tailored, family-centered prevention interventions may be appropriate and efficacious in reducing HIV risk behaviors among Hispanic delinquent adolescents.
clinicaltrials.gov Identifier: NCT01257022.
... Reliability of sexual behaviour reporting is enhanced for short periods of recall, and drops for periods of six months or longer 147,[151][152][153][154] . Internet web-based diaries were successfully used in a study of HPV infection among sexually inexperienced, young, female university students 155 . ...
Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). The vast majority of these infections clear spontaneously. The small proportion that persists may result in substantial morbidity and treatment costs. High oncogenic risk HPV (HR-HPV) types, including HPV-16 and 18, are recognised unequivocally as the main causal factor for cervical cancer, and may also cause other anogenital neoplasms and head and neck cancers. Infections with types that have low oncogenic risk (LR-HPV), such as HPV-6 and -11, are associated with benign lesions including genital warts. Many projections of the impact of the new HPV vaccines and screening technologies use dynamic transmission models which require sound estimates of the probability of transmission upon exposure. Furthermore, biological and practical limitations of the current vaccines require that we explore as many prevention options as possible. A critical research question is whether condoms provide protection. The main aims of the thesis were to characterize patterns of HPV infection among heterosexual couples in a new relationship, to identify risk factors for HPV infection, and to estimate HPV transmission probabilities per partnership and per coital act. I carried out a preliminary Monte Carlo simulation to estimate the probability of HPV transmission, then designed and conducted a study of heterosexual couples. The thesis objectives were addressed using baseline data from the ongoing HITCH Cohort Study (HPV Infection and Transmission among Couples through Heterosexual activity). The study population consists of young (aged 18-24) women attending a university or junior college (CEGEP) in Montreal and their male partners. Results from the simulation analysis suggested that HPV is highly transmissible, which was confirmed by the cross-sectional analysis of the HITCH study. Among the 263 couples enrolled between 05/2005 and 08/2008, HPV prevalence was 56% among women and men. In nearly two thirds (169) of couples, at least one partner was infected with one or more types. The current partner’s status was the most important risk factor for prevalent infection. Analysis of the patterns of type-specific concordance and discordance revealed that the extent of concordance was far greater than expected, and was consistent with rapid transmission between partners. There was evidence for a protective effect of condoms, but protection was incomplete and was stronger among men than among women. There are two unique features of the study that are novel for HPV research. It is the first large-scale study of HPV acquisition that involves the male partner. Secondly, it is the only study to restrict enrolment to couples in a new sexual relationship, a time at which considerable transmission is believed to occur. Results are likely to influence prevention efforts for cervical cancer and other HPV-related disease, including behavioural strategies to reduce risk. Results will also provide improved estimates of HPV transmission parameters to be used in models of the population health impact and cost effectiveness of vaccination strategies. Le virus du papillome humain (VPH) est l'infection transmissible sexuellement (ITS) la plus répandue. Une grande majorité des infections à VPH se résorbent spontanément. Cependant, la petite proportion d’infections à VPH persistantes peut avoir des coûts substantiels de traitement et de morbidité comme conséquence. Des génotypes de VPH à haut risque oncologique (HR-HPV), y compris HPV-16 et 18, sont identifiés sans équivoque comme facteur causal principal pour le cancer cervical, et peuvent également causer d'autres cancers anogénitaux, de la tête et du cou. Les infections avec des génotypes de VPH à bas risque oncologique (LR-HPV), comme HPV-6 et -11, sont associées aux lésions bénignes comprenant les verrues génitales. Plusieurs projections de l'impact des nouveaux vaccins de VPH et des techniques de dépistage utilisent des modèles de transmission dynamiques qui exigent des évaluations précises de la probabilité de transmission lors de l'exposition. En outre, les limitations biologiques et pratiques des vaccins courants exigent que nous explorions autant d'options de prévention que possibles. Une question critique de recherches est de savoir si les condoms assurent une protection. Les objectifs principaux de la thèse consistaient à caractériser des modèles typiques d’infection au VPH parmi les couples hétérosexuels dans une nouvelle relation, identifier des facteurs de risque pour l'infection au VPH, et estimer les probabilités de transmission du VPH par relation de couple et par acte coïtal. J'ai effectué une simulation préliminaire de Monte Carlo pour estimer la probabilité de transmission de VPH, puis j’ai conçu et entrepris une étude des couples hétérosexuels. Les objectifs de thèse ont été élaborés en utilisant les données de base de l'étude de cohorte HITCH (HPV Infection and Transmission among Couples through Heterosexual activity) qui se poursuit toujours. La population de l’étude est composée de jeunes femmes âgées de 18 à 24 ans, étudiantes à l’université ou au collège (CEGEP) à Montréal et leurs partenaires masculins.Les résultats de l'analyse de simulation ont suggéré que le VPH a un taux de transmission élevé, ce qui a été confirmé par l'analyse des coupes de l'étude HITCH. Parmi les 263 couples inscrits entre 05/2005 et 08/2008, la prévalence de VPH était de 56% parmi les femmes et les hommes. Dans approximativement deux tiers (169) des couples, au moins un des deux partenaires était infecté par un ou plusieurs types. Le statut actuel du partenaire était le facteur de risque le plus important pour la propagation de l'infection. L'analyse des modèles de concordance et de discordance des génotypes-spécifiques a indiqué que l'ampleur de la concordance était beaucoup plus importante que prévue, et était cohérant avec une transmission rapide entre les partenaires. Il y avait d'évidence d’un effet protecteur des condoms, mais la protection était incomplète et était plus forte parmi les hommes que parmi des femmes. Il y a deux dispositifs uniques dans l'étude qui sont nouveaux dans la recherche sur le VPH. C'est la première étude à grande échelle sur l'acquisition de VPH qui fait participer les partenaires masculins aussi. Deuxièmement, c'est la seule étude qui limite son recrutement qu’aux couples dans une relation sexuelle récente, période pendant laquelle on croit qu’une transmission considérable de VPH se produit. Les résultats sont susceptibles d'influencer les efforts de prévention du cancer du col de l’utérus et toute autre maladie liée à une infection de VPH, mais aussi les stratégies comportementales pour réduire le risque. Les résultats fourniront également des meilleures estimations des paramètres de transmission de VPH à employer dans les modèles de santé des populations et de rentabilité des stratégies de vaccination.
... Finally, it is often claimed that self-reports of sexual behavior are not concordant between partners. In fact, studies that enroll both partners find that reports for recent behaviors (frequency of coitus, types of sex, condom use) tend to be quite consistent, with rates of concordance 75% or higher (Bell, Montoya, & Atkinson, 2000;Harvey, Bird, Henderson, Beckman, & Huszti, 2004;James, Bignell, & Gillies, 1991;Lagarde, Enel, & Pison, 1995;Sison, Gillespie, & Foxman, 2004;Upchurch et al., 1991). With respect to reporting the existence of a sexual relationship, which was the focus of this article, the data suggest concordance may be higher still. ...
Accurate data on sexual behavior have become increasingly important for demographers and epidemiologists, but self-reported data are widely regarded as unreliable. We examined the consistency in the number of sexual partners reported by participants in seven population-based surveys of adults in the U.S. Differences between studies were quite modest and much smaller than those associated with demographic attributes. Surprisingly, the mode of survey administration did not appear to influence disclosure when the questions were similar. We conclude that there is more consistency in sexual partnership reporting than is commonly believed.
Studies about sexual health require accurate information on sexual behaviours, yet there is no gold standard for assessing sexual behaviour. Concordance of partner reports is one way to estimate the reliability and, indirectly, the validity of such data. We aimed to evaluate the inter-partner concordance of self-reported intercourse frequency among mixed-sex couples attempting conception. We analyzed data from Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study. During 2013–2021, self-reported intercourse frequency at baseline was ascertained using the same question for both partners: “In the past month, about how often did you have sexual intercourse with your partner?” with categorical response options. We used unweighted and linear-weight weighted kappas to assess inter-partner concordance of reported intercourse frequency and log-binomial regression to estimate unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for predictors of discordance. Among 3,015 couples, 1,927 (63.9%) reported exactly concordant categories of intercourse frequency, while the female partner reported more frequent intercourse in 715 (23.7%) couples and the male partner reported more frequent intercourse in 373 (12.4%) couples. Unweighted and weighted kappas were 0.50 (95% CI 0.48, 0.53) and 0.63 (95% CI 0.61, 0.65), respectively. Predictors of discordance included marital status (unmarried versus married: PR = 1.61 [95% CI 1.11, 2.29] for the male partner reporting more frequent intercourse) and longer relationship length (5–9 years, PR = 1.14 [95% CI 0.96, 1.34]; ≥ 10 years, PR = 1.14 [95% CI 0.92, 1.42], respectively, compared with < 5 years) for the female partner reporting more frequent intercourse.
The total survey-error perspective delineates the many ways in which error can undermine data quality and lower the reliability and validity of survey-based information. Chief among the sources of error are those related to (i) sampling, including frame inadequacies/limitations, selection, and sampling variation; (ii) nonobservation, including noncoverage and nonresponse; and (iii) observation/measurement error. The observation/measurement error includes collection matters related to the data-collection medium, auspice, instrument design, interviewers, respondent characteristics, processing, and analysis procedures. When it comes to the topic of sexual behavior, all of these standard sources of error apply and a number of these error sources get magnified. This chapter examines these sources of error and discusses how they apply to the study of sexual behavior. There are many impediments to obtaining high quality data for studying sexual behavior. But by following best practices, errors can be minimized and data that are usable can be collected.
This is the first part of a project dealing with both a formation process of pair bonding been adults and some disadvantageous factors affecting the bonds. The literature review on pair bonding is presented. Four factors constituting pair bonding are discussed: (1) the number of sexual partners, (2) whether or not one was subject to sexual abuse, (3) exposition to pornography, (4) the age at which one became sexually active. In the research part, subjective assessment of the quality of sexual life and the influence of the four above-mentioned factors on this assessed quality are studied. Major findings include: (1) the stronger was the experience of sexual abuse; the assessed quality of the current pair bond is the worse, (2) the more painfully was the sexual abuse experienced, the greater the number of sexual partyers one has had, the more one has been exposed to pornography and the earlier one became sexually active.
Background:
African American women who have sex with women (WSW) are emerging as a population at risk for sexually transmitted infections (STIs). The objectives of this study were to explore partnership characteristics for a cohort of African American WSW and evaluate those characteristics as potential risk factors for STIs. In addition, we aimed to determine STI diagnoses and identify predictors of STI infection.
Methods:
Women who have sex with women presenting to a sexually transmitted disease clinic in Birmingham, AL, completed a questionnaire and were tested for bacterial vaginosis, trichomoniasis, chlamydia, gonorrhea, Mycoplasma genitalium, syphilis, HIV, and herpes simplex virus type 2.
Results:
A total of 163 women were enrolled: 78 WSW and 85 women who have sex with women and men (WSWM) (based on report of past year sexual behavior). Both WSW and WSWM reported similar numbers of female partners over the lifetime, past year, and past month; however, WSWM reported significantly more lifetime male partners, thus having a higher overall number of sexual partners. Women who have sex with women and men were more likely to report new or casual partner(s), group sex, history of STIs, and sex with partner(s) known to have STIs. Overall, WSWM were more likely to have a current diagnosis of bacterial vaginosis, a current diagnosis of a curable STI, or a diagnosis of a noncurable STI (85% vs. 56%, P < 0.01).
Conclusions:
African American WSW are not a homogeneous group, and their sexual health may be directly or indirectly influenced by male partners. A better understanding of the distinctions and differences between African American WSW and WSWM will enable health care providers to improve the quality of care provided.
One of the most difficult problems of behavioral research on human sexuality and drug use is its reliance on people's self‐reports about their behavior. Given the essentially private nature of sexual and drug‐taking practices, many aspects of these practices are difficult, even impossible, to validate. The lack of a gold standard for self‐reports is particularly troubling with regard to HIV‐related behavior. To the extent that self‐reports are affected by response bias, the prevalence of high risk practices will be underestimated, hindering efforts to slow the spread of HIV. In this paper the extent of response bias in seven measures of high‐risk injection‐related and sexual behaviors is estimated. Self‐reported high‐risk injection practices may be significantly to substantially underreported due to response bias, whereas self‐reports of some high‐risk sexual practices do not appear to be contaminated by response bias. In regression analyses, the response bias in self‐reports of needle sharing and other high‐risk injection practices was modeled, and estimates of the probable actual prevalence of these practices derived. In situations in which behavioral self‐reports cannot be validated, such derivations may help in arriving at more accurate estimates of behavior.
Individuals' perceptions about their sex partners' sexually transmitted disease (STD)‐ and human immunodeficiency virus (HIV)‐related risk behaviors may affect their sexual behavior. The objective of this study was to determine the agreement between individuals' perceptions about their main sex partners' risk behaviors and their main sex partners' self‐reported risk behaviors. One hundred individuals and their current main heterosexual partner were recruited from a public STD Clinic. Participants were questioned separately from their main sex partner about their own risk behaviors and about their perceptions of their main sex partner's risk behaviors. Risk behaviors included more than one sex partner in the last three months, ever having had sex with another man (for male partners only), having used crack cocaine in the last three months, and ever having used injection drugs. For most of the risk behaviors, there was fair to moderate agreement between subjects' perceptions and their main sex partners' reported behavior (kappa scores ranged from 0.51 to 0.81). There was poor agreement between females' perceptions and their partners' report of ever having had sex with a man (kappa score=0.24). Furthermore, for most risk behaviors more than one third of participants thought that their partner had not engaged in a risk behavior when, in fact, they had. These findings are worrisome from a health education perspective. Individuals are either not asking about, or are being given false information about, their partners' HIV‐related risk behaviors and, thus, may not be taking necessary precautions.
Unreliable self‐reporting of sexual behavior has been suggested as a major cause of variance in survey research. In addition, differing gender‐related biases are thought to account for discrepancies in reports of oral and anal sex. Insufficient attention, however, has been given to assessing the reliability of the sexual partner's reports. Data obtained from 70 couples concerning 68 sexual behaviors was reviewed. Four different reliability indices yielded moderate to substantial agreement. These included a simple percentage criterion of 87%, a Kappa of .67, and conditional probabilities of .77 and.91. Previously reported discrepancies in the reporting of oral and anal sex were not found. Kappa was found to be superior to simple percentage agreement, but produced overly conservative reliability estimates when derived from behaviors that occur at either high or low base‐rates. The two conditional probability indices are proposed for use in conjunction with Kappa to evaluate the reliability of partner data.
The interpartner concordance of self‐reported sexual behavior among college dating couples (N = 119 couples, total N = 238) was assessed using self‐administered questionnaires. Moderate to high agreement (≥ 75%) was found for (a) a range of sexual behaviors, including all types of penetrative intercourse; (b) behaviors related to vaginal and oral intercourse (e.g., condom use, alcohol use); and (c) pregnancy‐prevention discussion. Partners' reports of when they first met, first dated, and began steadily and exclusively dating were significantly correlated (all ps < .001). In contrast, less agreement was observed for the occurrence of safer sex discussion beyond pregnancy prevention (e.g., past sexual histories; < 75%) and sexual behaviors involving the anus and men's genitals (< 60%), primarily because of men's failure to report these behaviors. Participants had moderate awareness of their partner's attitudes toward casual sex, but low awareness of their attitudes toward condom use and sexual responsibility. Greater concordance about sexual and safer sex behavior was generally present in couples in which the male partner was younger and had a restricted sociosexuality. Men who were virgins prior to their current relationship and/or who had specifically discussed the woman's past sexual history had greater knowledge about their partner's past and concurrent sexual behavior. Methodological and applied implications of these findings for both clinical and empirical sexuality domains are discussed.
The probability of HIV-1 transmission per coital act in representative African populations is unknown. We aimed to calculate this probability overall, and to estimate how it is affected by various factors thought to influence infectivity.
174 monogamous couples, in which one partner was HIV-1 positive, were retrospectively identified from a population cohort in Rakai, Uganda. Frequency of intercourse and reliability of reporting within couples was assessed prospectively. HIV-1 seroconversion was determined in the uninfected partners, and HIV-1 viral load was measured in the infected partners. Adjusted rate ratios of transmission per coital act were estimated by Poisson regression. Probabilities of transmission per act were estimated by log-log binomial regression for quartiles of age and HIV-1 viral load, and for symptoms or diagnoses of sexually transmitted diseases (STDs) in the HIV-1-infected partners.
The mean frequency of intercourse was 8.9 per month, which declined with age and HIV-1 viral load. Members of couples reported similar frequencies of intercourse. The overall unadjusted probability of HIV-1 transmission per coital act was 0.0011 (95% CI 0.0008-0.0015). Transmission probabilities increased from 0.0001 per act at viral loads of less than 1700 copies/mL to 0.0023 per act at 38 500 copies/mL or more (p=0.002), and were 0.0041 with genital ulceration versus 0.0011 without (p=0.02). Transmission probabilities per act did not differ significantly by HIV-1 subtypes A and D, sex, STDs, or symptoms of discharge or dysuria in the HIV-1-positive partner.
Higher viral load and genital ulceration are the main determinants of HIV-1 transmission per coital act in this Ugandan population.
Background: Available literature shows that association of alcohol and/or drug use with unsafe sexual practices is not established, in contradistinction to the well-established association between such substance use and the sexual milieu itself. Goal: To analyze these two kinds of associations in a population-based sample of heterosexuals in France. Study Design: Cross-sectional telephone survey of the French adult heterosexual population in the early 1990s (n = 4213). Results: Subjects at risk were more likely than those not at risk to have consumed alcohol before sex; this was not the case for drug use. However, at-risk subjects who engaged in unsafe practice(s) were not more likely to have consumed alcohol or drugs. Conclusion: Alcohol consumption appears to be a marker for being in an at-risk situation in France and may be used as such by public health providers. In contrast, the association between alcohol/drug use and unsafe sexual practices is not supported by our study and thus conflicts with prevention strategies to increase compliance with safer sex through alcohol/drug abstinence.
A method is described for fabricating an expanded anode wherein the anode is comprised of a pair of planar anode plates attached to an anode post, the pair of planar anode plates parallel to each other and separated by the diameter of the anode post. The method comprises expanding the anode by bending each plate, while attached to the anode post, to a position wherein the plates are substantially parallel to each other and the distance between the parallel portion of the plates is greater than the diameter of the anode post except where the plate is attached to the post.
Seventy‐five male couples, where one member was HIV‐positive and his partner was HIV‐negative, were assessed concerning anal sexual‐risk behavior. Subsequently, the reliability of their self‐reports was determined by two methods: (a) by comparing the separate reports of each member of the couple and (b) by a one week test‐retest of 27 individuals. Both quantitative and qualitative assessment methods were used. Approximately half of the men had practiced anal sex with their serodiscordant partners during the year prior to the interview, and between half and one quarter of those men reported not using protection consistently. After careful analyses of the discrepancies found in the self‐report of the members of some couples, it was established that, for the most part, primary partners confirmed the report of index respondents concerning their sexual behavior with each other. The most frequent reasons for interpartner discrepancies were poor recall of isolated incidents, inaccuracy in limiting responses to the given time frame, different interpretations of what constitutes sex (despite precise and clear definitions in the assessment), and plain lack of agreement about what actually took place. Also, over a one week period individuals were consistent in the report of the frequency of various sexual behaviors they performed with their primary partners.
Health psychologists working within a “social cognition” framework routinely regard verbal reports as indices of cognitive/mental representations and behavioural dispositions. Social cognition developed within social psychology but the philosophy of science, theoretical assumptions and methodological practices which constitute it are not universally accepted by social psychologists. This paper explores the implications of debates about the validity of a social cognitive perspective for research practice in health psychology. The realist foundations of social cognition are contrasted with the social constructionist perspective underpinning many discourse analysis studies. It is argued that a realist view of potentially accurate verbal reports and an individual cognitive focus are essential to health psychology research. However, it is emphasized that culture-bound self-presentational processes operating in data-collection contexts necessitate methodologies capable of monitoring and controlling the impact of those contexts on the content of collected verbal reports. Various methodological approaches are discussed and illustrative studies are used to demonstrate how cognitive categorizations of verbal reports can be used to predict health outcomes.
The results of a massive telephone survey of sexual lifestyles in France
should provide a basis for prevention strategies for AIDS and sexually
transmitted diseases.
Objectives:: Although genital ulcer disease (GUD) has been associated with human immunodeficiency virus (HIV) infection in a number of studies, definitions of genital ulceration have varied. The authors hypothesized that the association of GUD with prevalent HIV infection may vary according to the definition of GUD that is used.
Methods:: As part of a prospective cohort study, 863 patients were interviewed and examined who presented to a sexually transmitted disease (STD) clinic for new symptom evaluation and who agreed to HIV testing to determine demographic and behavioral risk associated with prevalent HIV infection. To determine the association between GUD and prevalent HIV, the following definitions of GUD were used: observed ulcers, history of syphilis, serologic evidence of syphilis, observed culture‐proven genital herpes, and serologic evidence of herpes simplex virus type II (HSV‐2) infection.
Results:: Of 481 men and 382 women enrolled, prevalent HIV infection was detected in 12.5% and 5.2%, respectively. In multivariate analyses controlling for known HIV risk behaviors, prevalent HIV infection was associated with observed GUD (odds ratio [OR] = 2.0, 95% confidence intervals (CI) = 1.0–3.9), a history of syphilis (OR = 6.0, CI = 2.8–12.7), and serologic evidence of syphilis (OR = 3.7, CI = 1.9–7.0), but not with serologic evidence of HSV‐2 (OR = 1.2, CI = 0.7–2.1), nor with observed HSV‐2 culture‐positive genital ulcerations (OR = 1.0, CI = 0.4–4.2). Factors contributing to different strengths of association between HIV infection and a history of syphilis or serologic evidence of syphilis included the presence of under‐diagnosed syphilis infection in people with reactive serologic tests and the absence of serologic reactivity in people with a positive history.
Conclusions:: Although GUD is strongly associated with prevalent HIV, the strength of the association depends on the definition of GUD used. For accurate evaluation of people at risk for HIV, clinicians and researchers should use multiple definitions of GUD.
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Despite the importance of the issue for AIDS-related research, there is a paucity of studies that have addressed the issue of the validity of self-reports of patterns of risk behavior over time. This article frames issues of measurement in the context of cognitive psychology and presents a research paradigm that investigators can use to explore issues of accuracy, bias, and stability in self-reports. The paradigm also permits the analysis of transitory influences on risk behavior, influences which have been minimized in current AIDS research. Preliminary data are presented that support the feasibility of the method and which are suggestive of important considerations in the development of valid measures in national surveys.
This study examined the association of two types of condom use outcome expectancies (self-approval and partner reaction) with patterns of safer sexual behavior among predominantly African American patients at a sexually transmitted diseases (STD) clinic. As expected, both individuals' own self-approval outcome expectancies and their partner reaction outcome expectancies predicted consistency of condom use, although partner reaction expectancies predicted condom use above and beyond the effects of self-approval expectancies. Furthermore, individuals who believed that they and their partner shared positive condom use outcome expectancies reported the greatest use of condoms. These findings suggest that HIV prevention programs should address both types of condom use outcome expectancies in order to maximize behavior change.
We tested the impact of four social cognitive constructs (multifaceted condom use self-efficacy and hedonic, social, and self-evaluative outcome expectations) on sexual risk behavior change. Each construct was hypothesized to have an independent effect on four indicators of behavior change: consistency of reported condom use, condom use at last intercourse, frequency of unprotected intercourse acts, and stage of condom use behavior change. STD clinic patients (n = 472) were recruited, given baseline interviews, and placed in small-group health education sessions. Three-month follow-up interviews were conducted. Hypotheses were tested with logistic regressions and general linear models. Results showed that baseline self-efficacy and hedonistic expectations regarding condom use predicted sexual behavior and stage of change. In addition, follow-up levels of each of two additional outcome expectation domains, expected partner reaction and self-approval for condom use, were associated with sexual behavior at follow-up, controlling baseline levels of each dependent variable. These latter outcome expectations accounted for the greatest proportion of the variance among the SCT factors. These results support a social cognitive model of condom use behavior change and provide important clues for refining condom promotion interventions.
Objective:
To develop a multidimensional classification of sexual partnerships.
Methods:
Eighty-two female subjects (ages 15-20 years; 77% African American) used coital logs to record dates of 1265 coital events, partner initials, and condom use. Logs were collected at 1-, 3-, 9-, 15-, and 21-month return visits. Three adolescent health professionals independently classified partnership patterns of each subject; classification schemes were revised until complete consensus for each subject was obtained.
Results:
Complete agreement in partnership classification was reached after 3 rounds. The consensus partnership classification had three dimensions: number (1, > or = 2 partners), pattern (1 partner, serially exclusive, concurrent), and duration (any partnership < or = 21 days, all partnerships >21 days). A total of 34 of 82 (34%) of subjects had > or = 2 partners; 11 of 34 (32%) had concurrent partnerships. Twenty of 82 (24%) had only partnerships lasting >21 days. Condom use was less common for subjects in only longer-term (>21 days) partnerships, but did not significantly vary by number or pattern.
Conclusion:
Multiple dimensions of adolescent sexual partnerships may be identified. Detailed research and clinical assessments along these dimensions may improve understanding of protective behaviors such as condom use.
To compare responses to a sexual behavioral survey of spouses in cohabiting heterosexual relationships in Kigali, Rwanda.
Cross-sectional survey.
Husbands and wives in 779 cohabiting couples were interviewed separately with parallel questionnaires. Participants were recruited from a three-year old cohort of 1458 antenatal clinic attendees enrolled in a prospective study in 1988. Analyses compared responses at the gender- and couple-level for agreement and disagreement.
Couples were in disagreement more than agreement. Women reported occasionally refusing sex, suggesting condom use, and believing married men were unfaithful. Men reported being in a faithful relationship, greater condom use, and being understanding when wives refused sex. Agreement included relationship characteristics, safety of condoms, and whether condoms had ever been used in the relationship. Disagreement included the preferred timing of next pregnancy, desire for more children, and whether a birth control method was currently used and type of method.
Rwandan husbands and wives differed in sexual behavior and reproductive-related topics. Couple-level reporting provides the most reliable measure for relationship aspects as couples' agreement cannot be assumed among cohabiting partnerships. Furthermore, HIV prevention programs for couples should incorporate communication skills to encourage couple agreement of HIV-related issues.
In Cayenne, French Guiana, 80% of HIV-positive patients followed at the hospital are migrants. Behavioural information is crucial for optimising HIV testing for this vulnerable group. Predictors of ignorance of the existence of free voluntary counselling and testing (VCT) centre and willingness to get tested were investigated in 2006 among 398 migrants from Haiti, Guyana, Suriname and Brazil using a structured questionnaire. Only 27% of migrants knew simultaneously about the existence of free VCT, its localisation and its operating hours. Factors associated with ignorance of the existence of free VCT centre were birthplace in Haiti, being in French Guiana for less than three years, not thinking one's birth country as strongly affected by HIV and not thinking to be personally at risk for HIV. Factors independently associated with willingness to get tested were thinking to be at risk for HIV, birthplace in Brazil and Haiti, having a high-integration level and fear of suffering if HIV test was positive. In order to improve testing among migrants, the accessibility of testing facilities and the knowledge of their whereabouts and operating hours must be improved to promote the desired behaviour among the majority of migrants which is often willing to do the test.
This dissertation examines elements of adolescents’ socioeconomic and behavioral transition to adulthood. It consists of three separate studies, each relying on a different large-scale panel study that follows the same set of young people over time. Two of the studies examine adolescents in the contemporary United States while the other examines adolescents in contemporary urban South Africa. In the second chapter, I examine whether or not changes in the structure of U.S. social welfare policies in the mid-1990s, specifically those that incentivized and tied social support to participation in the paid labor force, had any effect on rates of U.S. long-term child poverty. I find that long-term poverty dropped substantially for black and white children of the post-reform cohort, with about 1 in 5 black children and 3.6 percent of white children classified as long-term poor, compared to pre-reform rates of 1 in 3 black children and 5.8 percent of white children. In the third chapter, I examine the link between contextual disadvantage and the likelihood that an adolescent’s relationship is “embedded” in common social contexts and peer groups. I find that adolescents form relationships with partners from various contexts and that neighborhood and school disadvantage help determine the social contexts from which adolescents know their partners. In the fourth chapter, I examine the link between paternal absence and sexual debut among adolescents in Cape Town, South Africa. I find that the absence of a father from a child’s household, net of other observed factors, increases the likelihood of adolescent sexual debut by age 16, although the effect differs by race and gender. In sum, the examination of race and gender differences inherent in each of these studies reminds social scientists that the social environment external to an individual interacts with the individual’s personal characteristics, implying that there is heterogeneity in the “effects” of the family and social context on individual outcomes and that understanding these heterogeneous effects among adolescents is required for moving toward a more holistic, life-course understanding of the racial and gender differences observed in adult outcomes.
In contrast with the psychologically based individualistic models of health behaviour in which conduct adopted in response to AIDS risk is seen as an individual decision depending on the processing of information, we postulate that individuals construct their own definition of the risk of HIV transmission by drawing on their socio-sexual lifecourse and the type of sexual relationships in which they are engaged. Data were obtained from a random sample of 4820 people living in France interviewed by telephone between September 1991 and February 1992. This analysis was conducted on a subgroup of 1508 men and 1376 women in sexual relationships of less than five years. Multiple correspondence analysis and logistic regression were performed. Our findings show that the adoption of preventive behaviour is far from depending exclusively on the awareness of risk. Individuals having a diversified sexual experience, who talked about sexuality during their childhood and have personal confidants more often reported having changed their sexual behaviour because of AIDS. Although less likely to select their partner in order to reduce the risk of AIDS, they more often adopt strategies directly linked to sexual interaction such as condom use. Individuals belonging to networks in which condom use is the norm are more likely to use them. Women, for whom stable relationships propitious to the development of emotional closeness carry a high social value, are more likely to rely on uniquely relational strategies in which the adaptation to the risk of infection involves a better knowledge of the partner. Our findings reveal that individuals attach a different degree of risk to their partners depending on whether they occupy a central or peripheral place in their network of sociability. Furthermore, we observed an incompability between the preventive and the socio-affective rationale in which condom use is inversely related to the degree of intimacy, regardless of what is known about the partner's serological status. Risk adaptation strategies are thus far from being irrational, but are related to individuals' socio-sexual biography, the logics of gender, social networks and milieux of sociability, and depend ultimately on the context of the relationship. As with other health-related behaviour, coping strategies appear to be the product of a complex interaction of biographical, social and cultural threads. Prevention campaigns based exclusively on the promotion of individual responsibility are thus likely to miss the mark.
Individuals' accurate assessment of their exposure to the risk of HIV and other STDs requires awareness of their sexual partners' risk behaviors and disease status.
In a sample of 217 couples enrolled in a risk intervention trial in 1997-2002, both partners reported on their own risk behaviors and their perceptions of their partner's behavior; concordance of partners' reports was examined using kappa statistics. Individual and relationship characteristics predicting lack of awareness of a partner's risk behavior were explored using multivariate logistic regression.
Three percent of women and 14% of men were unaware that their partner had recently had a concurrent partner. Eleven percent and 12%, respectively, were unaware that their partner had ever injected drugs; 10% and 12% were unaware that their partner had recently received an STD diagnosis; and 2% and 4% were unaware that their partner was HIV-positive. Women's lack of awareness of partner risk was associated with increasing age (odds ratio, 1.1), being of a race or ethnicity other than black or Latina (15.8) and having a Latino partner (3.7); it was positively associated with a man's report that he was married (4.4) and with relationship satisfaction as reported by both the woman and her partner (1.2 for each). Among men, lack of awareness was positively associated with partner's age (1.1) and with having a partner who was formerly married (8.2).
Couple-based interventions that assess each partner's awareness of the other's risk behavior may help programs better target couples' STD prevention needs.
To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)-preventive behaviors and psychosocial mediators.
A randomized controlled trial of an HIV prevention program.
Clinic-based sample in Atlanta, Georgia.
African American adolescent females (N = 715), aged 15 to 21 years, seeking sexual health services. Participants completed an audio computer-assisted self-interview and provided self-collected vaginal specimens for STD testing. Intervention Intervention participants received two 4-hour group sessions and 4 telephone contacts over a 12-month period, targeting personal, relational, sociocultural, and structural factors associated with adolescents' STD/HIV risk, and were given vouchers facilitating male partners' STD testing/treatment. Main Outcome Measure Incident chlamydial infections.
Over the 12-month follow-up, fewer adolescents in the intervention had a chlamydial infection (42 vs 67; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.42 to 0.98; P = .04) or recurrent chlamydial infection (4 vs 14; RR, 0.25; 95% CI, 0.08 to 0.83; P = .02). Adolescents in the intervention also reported a higher proportion of condom-protected sex acts in the 60 days preceding follow-up assessments (mean difference, 10.84; 95% CI, 5.27 to 16.42; P < .001) and less frequent douching (mean difference, -0.76; 95% CI, -1.15 to -0.37; P = .001). Adolescents in the intervention were also more likely to report consistent condom use in the 60 days preceding follow-up assessments (RR, 1. 41; 95% CI, 1.09 to 1.80; P = .01) and condom use at last intercourse (RR, 1.30; 95% CI, 1.09 to 1.54; P = .005). Intervention effects were observed for psychosocial mediators of STD/HIV-preventive behaviors.
Interventions for African American adolescent females can reduce chlamydial infections and enhance STD/HIV-preventive behaviors and psychosocial mediators of STD/HIV-preventive behaviors. Trial Registration clinicaltrials.gov Identifier: NCT00633906.
To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents.
A randomized controlled trial. Participants completed baseline and follow-up assessments.
An urban public hospital in the Southeastern U.S.
Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic.
Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition.
Consistent condom use.
Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex.
Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.
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