Abstract
Purpose This study sought to determine whether including two types of questions in surveys administered via face-toface interview can contribute to more accurate measures of correct and consistent condom use among populations at risk for HIV. The study compared initial rates of selfreported condom use to rates found when respondents were asked to provide confirmation of correct and consistent use via follow-up questions. Methods Paired t-test analyses were conducted on data from 11 surveys of female sex workers and men who have sex with men, from five Central American countries and the Dominican Republic. All surveys included either a testretest item for consistent condom use or else a combination of the test-retest item and a second item measuring correct condom use. Results In all 11 datasets, the proportion of respondents qualifying as consistent condom users decreased significantly after answers to either one or both follow-up questions were taken into account. In the six datasets from surveys of female sex workers, the difference between the initial and final level of self-reported condom use ranged from 4.3% to 23.2%. In the five datasets from surveys of men who have sex with men, the difference between the initial and final level of self-reported condom use ranged from 9.9% to 37.0%. Conclusion Given the amount of recall bias and social desirability bias usually associated with condom use survey items, a measure that identifies a lower proportion of condom users than initially found is taken to be more accurate. The two follow-up questions examined in this study appear to substantially reduce the proportion of people claiming consistent condom use. As most behavioral surveys rely on self-reported measures, the addition of such questions could significantly improve estimates of consistent condom use. We therefore recommend that these and other types of follow-up items be added to future condom use surveys and evaluated further as potential means of obtaining more accurate information about this important behavior. Background
Highlights
Worldwide, sexual contact is the most common route of HIV transmission among general populations, as well as among specific subgroups such as commercial sex workers and men who have sex with men [1]
In all 11 datasets, the proportion of respondents qualifying as consistent condom users decreased significantly after answers to either one or both follow-up questions were taken into account
Given the amount of recall bias and social desirability bias usually associated with condom use survey items, a measure that identifies a lower proportion of condom users than initially found is taken to be more accurate
Summary
Sexual contact is the most common route of HIV transmission among general populations, as well as among specific subgroups such as commercial sex workers and men who have sex with men [1]. Recent evidence indicates that while self-administered instruments such as computer-based surveys appear to often yield higher and more plausible estimates of sexual risk behavior, this superiority may well be compromised by the potential for the respondent to not understand questions. This could result in higher item non-response as well as skewed responses [11,12]. With the possible exception of highly literate groups, some version of face-to-face interviewing appears to still be the optimal way to gather condom use data
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