Sensitive Sexual Behaviours Research Articles

An effectiveness-implementation trial protocol to evaluate PrEP initiation among U.S. cisgender women using eHealth tools vs. standard care.

The United States' (U.S.) initiative to End the HIV Epidemic aims to reduce new HIV infections in areas of high HIV prevalence. Despite national efforts to reduce HIV incidence, cisgender women continue to represent approximately one out of every five new HIV diagnoses in the U.S. Taking pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy; however, PrEP initiation among cisgender women is suboptimal, with only 10% of eligible women receiving PrEP prescriptions in 2019. We designed a trial to test the effectiveness of interventions to increase PrEP initiation, while evaluating the implementation strategy (hybrid type II trial) in seven obstetrics and gynecology (OB/GYN) clinics (two federally qualified health centers, three community-based, and two academic) in Baltimore, Maryland. A total of 42 OB/GYN providers will be enrolled and randomized (1:1:1) into one of three clinical trial arms (standard of care, patient-level intervention, or multi-level intervention). Eligible patients of enrolled providers will receive a sexual health questionnaire before their appointment through the electronic health record's (EHR) patient portal. The questionnaire will be scored in three tiers (low, moderate, and high) to assess HIV risk. Patients at low risk will be offered an HIV test only, while those who score medium or high risk will be included in the clinical trial and assigned to the clinical trial arm associated with their provider. Differences in PrEP initiation, our primary outcome, across the three arms will be analyzed using generalized linear mixed-effect models with logistic regression. We will adjust results for demographic differences observed between arms and examine PrEP initiation stratified by patient's and provider's race and ethnicity.Additionally, a comprehensive economic analysis for each intervention will be conducted. We hypothesize that gathering information on sensitive sexual behaviors electronically, communicating HIV risk in an understandable and relatable format to patients and OB/GYN providers, and deploying EHR alerts will increase PrEP initiation and HIV testing. The trial is registered with ClinicalTrials.gov (NCT05412433) on 09 June 2022. https://clinicaltrials.gov/ct2/show/NCT05412433?term=NCT05412433&draw=2&rank=1.

The association between interviewer gender and responses to sensitive survey questions in a sample of Haitian women

ABSTRACTBias may be introduced in survey data collection when participants answer questions differently depending on interviewer gender. This could affect the validity of collected data, especially sensitive data. Using sexual behavior data collected in a 2017–2018 cross-sectional survey of Haitian women (n = 304), we evaluated the associations between interviewer-gender and three different outcomes: (1) question-specific response rates, (2) total number of non-responses, and (3) differences in reported answers. We observed higher item response rates for sensitive sexual behavior questions when the interviewer was female and more item non-responses (Don’t know/Refuse) when the interviewer was male. Among those who did respond, participants were more likely to report some sensitive sexual behaviors to women and others to men. We conclude that researchers should consider the sociocultural norms of the study population and the potential for interviewer gender bias in the planning and analysis phase of studies using self-reported data.

Effects of Experimenter Contact, Setting, Inquiry Mode, and Race on Women's Self-Report of Sexual Attitudes and Behaviors: An Experimental Study.

Factors related to the research context, such as inquiry mode, setting, and experimenter contact, may affect participants' comfort with and willingness to disclose certain sexual attitudes or admit to engaging in sensitive sexual behaviors. In this study, 255 female undergraduates (42.7 % non-White) completed a survey containing measures of sexual behavior and attitudes. The level of experimenter contact (high vs. low contact), setting (in lab vs. out of lab), and inquiry mode (pencil-and-paper vs. computer) were manipulated and participants were randomly assigned to conditions. We hypothesized that low-contact, out-of-lab, computer conditions would be associated with more liberal sexual attitudes and higher rates of reported sexual behaviors than high-contact, in-lab, and paper-and-pencil conditions, respectively. Further, we hypothesized that effects would be moderated by race, such that differences would be greater for non-White participants because of concerns that reporting socially undesirable behavior might fuel racial stereotypes. For attitudinal measures, White participants endorsed more liberal attitudes toward sex in high-contact conditions and non-White participants endorsed more liberal attitudes in low-contact conditions. For behavioral measures, non-White participants reported more behaviors on pencil-and-paper surveys than on computers. White participants demonstrated no significant mode-related differences or reported more sexual behaviors in computer conditions than paper-and-pencil conditions. Overall, results suggest that experimenter contact and mode significantly impact sexual self-report and this impact is often moderated by race.

An Empirical Validation Study of Popular Survey Methodologies for Sensitive Questions

When studying sensitive issues, including corruption, prejudice, and sexual behavior, researchers have increasingly relied upon indirect questioning techniques to mitigate such known problems of direct survey questions as underreporting and nonresponse. However, there have been surprisingly few empirical validation studies of these indirect techniques because the information required to verify the resulting estimates is often difficult to access. This article reports findings from the first comprehensive validation study of indirect methods. We estimate whether people voted for an anti‐abortion referendum held during the 2011 Mississippi General Election using direct questioning and three popular indirect methods: list experiment, endorsement experiment, and randomized response. We then validate these estimates against the official election outcome. While direct questioning leads to significant underestimation of sensitive votes against the referendum, indirect survey techniques yield estimates much closer to the actual vote count, with endorsement experiment and randomized response yielding the least bias.

Consistency in reporting sensitive sexual behaviours in Britain: change in reporting bias in the second and third National Surveys of Sexual Attitudes and Lifestyles (Natsal-2 and Natsal-3)

ObjectivesBritain's second National Survey of Sexual Attitudes and Lifestyles (Natsal-2) was conducted in 1999–2001 and the third (Natsal-3) was conducted in 2010–2012 to update prevalence estimates of sexual behaviours and...

How well do volunteer web panel surveys measure sensitive behaviours in the general population, and can they be improved? A comparison with the third British National Survey of Sexual Attitudes & Lifestyles (Natsal-3)

BackgroundTraditional modes of survey data collection show decreasing response rates and increasing costs. Web surveys potentially provide a cost-effective alternative. Opt-in volunteer web panels are widely used for market research or opinion polling, but less for academic or government research because of concerns about their representativeness arising from the effect of self-selection bias. Various methods attempt to make web panel surveys more representative of the population. We compared results from four UK web surveys with Natsal-3, a national probability sample survey. MethodsThe four web surveys were done by three UK market research companies, each with large volunteer web panels. A shortened Natsal-3 questionnaire was included on four web surveys: two used basic demographic quotas and two were modified with variables correlated with key outcomes as additional quotas. Panel members aged 18–44 years, who were resident in Great Britain, and who met the criteria set for the quotas were eligible. Each company was asked to provide a sample of 2000 participants, which achieved between 2000 and 2099 participants, with data collection between May and July, 2012. After weighting for age and sex, comparisons were made with Natsal-3 for demographic characteristics, key behaviours, and opinions, to examine whether modified quotas improved the results. We calculated mean absolute odds ratios (ORs) and the percentage of variables that significantly differed from Natsal-3 at the 5% significance level. We used Z tests based on bootstrap standard errors to assess whether the modified quota surveys provided estimates closer to Natsal-3 than the basic quota surveys. We used generalised estimating equations to assess whether the two modified quota surveys and likewise the two basic quota surveys provided consistent estimates. Six demographic and 35 behaviour or opinion variables were compared, including reporting of same-sex experience and attraction, vaginal sex in the past month, number of heterosexual partners, and attendance to a sexually transmitted infection clinic. FindingsAll four web surveys gave different results from Natsal-3 for most of the variables, and overall the two surveys with modified quotas did not provide estimates that were closer to Natsal-3 than the basic quota surveys. Estimates for men from the web surveys differed more from Natsal-3 than estimates for women. For men, the mean absolute OR was 1·81 for basic and 1·64 for modified surveys, and for women the results were 1·43 for basic and 1·42 for modified surveys. The differences between the web surveys and Natsal-3 were numerically greater for questions asked face-to-face than those asked in self-completion format, but no formal statistical comparison was made. The two modified quota surveys seemed to differ from each other (ie, were inconsistent, p=0·07), as did the basic quota surveys (p<0·0001). Adjustment of web panel quota controls did not lead to much improvement according to the results of Z tests, although for men improvements were more evident than for women. Moreover, meeting the modified quotas proved difficult, and the quotas had to be relaxed in both cases. InterpretationWhen measuring sensitive sexual behaviours in the Great Britain population, volunteer web panel surveys provided significantly different estimates than a probability computer-assisted personal interview or computer-assisted self-interview survey, and modified quotas did not clearly improve estimation. At present, non-probability web panels are not an appropriate means of gathering data if accurate estimates of population prevalence are the intention, regardless of whether quotas are basic or more sophisticated. This finding is consistent with findings from similar research from the USA and other European countries. FundingMedical Research Council and the Wellcome Trust.

OP33 How Well do Volunteer Web Panel Surveys Measure Sensitive Behaviours in the General Population, and can they be Improved? A Comparison with the Third British National Survey of Sexual Attitudes & Lifestyles (Natsal3)

BackgroundSurveys play an important role in providing public health data for researchers and policy-makers. Traditional interviewer-administered surveys are subject to declining response rates and increasing costs. With the spread of...

P3.343 How Well Do Web Panel Surveys Measure Sensitive Behaviours in the General Population, and Can They Be Improved? A Comparison with the Third British National Survey of Sexual Attitudes & Lifestyles (Natsal3)

BackgroundSurveys play an important role in providing public health data for researchers and policy-makers. Traditional modes of survey data collection are subject to declining response rates and increasing costs. With...

Consistency in the Reporting of Sensitive Behaviors by Adolescent American Indian Women: A Comparison of Interviewing Methods

Computer-assisted interviewing techniques have increasingly been used in program and research settings to improve data collection quality and efficiency. Little is known, however, regarding the use of such techniques with American Indian (AI) adolescents in collecting sensitive information. This brief compares the consistency of AI adolescent mothers' reporting of sensitive sexual and drug use behaviors gathered through three distinct interviewing techniques: computer-assisted (ACASI), self-administered questionnaire (SAQ), and face-to-face interview (FTFI). Endorsement of drug use and reporting of sexual activity was highest for ACASI, followed by SAQ, and was significantly lower for FTFI. Relatively strong agreement was measured between ACASI and SAQ, and relatively poor agreement was measured between the ACASI and FTFI. Findings support the use of computer-assisted interviewing techniques with AI adolescents, and implications for future research are discussed.

Informal confidential voting interviewing in a sexual risk assessment of men who have sex with men (MSM) and transgenders (hijra) in Bangalore, India

ObjectiveThe accuracy of self-reporting sensitive sexual risk behaviours is highly susceptible to misreporting. Informal confidential voting interviews (ICVIs) may minimise social desirability bias by increasing the privacy of the interview...

A Comparison of Survey Techniques on Sensitive Sexual Behavior in Italy

This article compares two national surveys carried out through the most commonly used procedures in Italy: CATI (computer-assisted telephone interviews) and SAQ-FI (self-answered questionnaires following interviews). Both surveys ask two identical questions concerning sensitive sexual behavior: early age at first intercourse and same-sex attraction. The SAQ-FI survey had both unit non-response and item non-response rates much lower than the CATI survey. Moreover, in the CATI survey, the groups with highest item non-response rates were also the groups with the lowest proportions of early intercourse and homosexual attraction. In addition, a differential analysis of the respondents produced diverse results for the two surveys. This is especially true of results by gender for same-sex attraction: Such behavior is more common among men (3.1%) than women (2.9%), according to the CATI survey, whereas the opposite is true of the SAQ-FI survey (6.1% of men vs. 7.7% women). In Italy at the beginning of the 21st century, CATI surveys reveal a lower level of early intercourse and same-sex attraction than SAQ-FI surveys. This article argues that the CATI survey underestimates the true level of these sensitive sexual behaviors in the Italian population.

Effect of Gender of the Recorded Voice on Responses to Sensitive Sexual Behavior Questions

Audio computer-assisted self-interview (ACASI) has been shown to reduce interviewer and social desirability bias related to sensitive questions, which can be especially important for studies of sexual behavior and HIV risk. Baseline demographic and HIV risk data were collected using ACASI for 849 adults aged 18–34 (423 males and 426 females) of unknown or HIV-negative status as part of an HIV-incidence cohort study in Kisumu, Kenya. ACASI questionnaires and possible responses were recorded being read either by a male or female voice in the three most commonly used languages (English, Kiswahili, and Dholuo). Participants were randomly assigned to hear either male or female voice. Dependent variables, including 12 sexual behavior questions, were evaluated using logistic regression. No significant differences in responses to the 12 sensitive questions were found for gender of the recorded voice on ACASI or for the interaction between gender of recorded ACASI voice and respondent gender.

Performance of audio-assisted confidential voting interview for assessment of sexual behavior among young adults in Chandigarh Union Territory

A cross-sectional study was conducted in Chandigarh Union Territory to evaluate the performance of an audio-assisted confidential voting interview (AVI), for assessing the sexual behavior among young adults aged 20 - 34 years. Using systematic random sampling 625 males and 630 females were interviewed alternately, either by AVI or by face-to-face interview (FFI). More men revealed having sex with men in AVI (2.6%) than FFI (0.6%) (P 0.06). Women reported having sex with non-regular partners more often in AVI (4.8%) compared to FFI (0.3%) (P < 0.001). AVI performed better than FFI for eliciting sensitive sexual behaviors.

The Evidence for the Role of Concurrent Partnerships in Africa’s HIV Epidemics: A Response to Lurie and Rosenthal

Standardizing of definitions and improving methods of measuring concurrency has been a preoccupation of many researchers recently. These discussions are further along than what Lurie and Rosenthal imply. In order to address the need for improved data collection on concurrency, a consultation was recently held by the UNAIDS Reference Group on Estimates, Modeling and Projections, which proposed the following definition of concurrency: overlapping sexual partnerships where sexual intercourse with one partner occurs between two acts of intercourse with another partner [23]. The meeting also proposed, in order to improve the comparability of data, the following primary indicator: the percentage of women and men ages 15–49 reporting more than one ongoing sexual partnership at the point in time 6 months before the interview [23]. While there may still be some limitations to this measurement—particularly in terms of finding more accurate sources of data for this type of sensitive sexual behavior—we hope that this consensus definition and indicator will improve the accuracy and generalizablity of further research.

Many vaginal microbicide trial participants acknowledged they had misreported sensitive sexual behavior in face-to-face interviews

Objective We investigated whether participants in a phase II randomized clinical trial of a candidate vaginal microbicide ever intentionally misled interviewers. Study Design and Setting We used audio computer-assisted self-interviews (ACASI) to ask the South African women ( n = 132) participating in the trial about the accuracy of self-reported data collected during face-to-face interviews. The trial protocol recommended that women use their assigned gel (active microbicide or placebo) with condoms during each vaginal sex act. Results Nearly four-fifths of participants ( n = 104, 79%) reported that they had misinformed trial interviewers at least once. Motivations included politeness ( n = 45, 34% of ACASI participants) to avoid criticism or seek praise ( n = 32, 24%), and embarrassment ( n = 24, 18%). Participants acknowledged misreporting eligibility characteristics to enroll (11%) and, during follow-up, exaggerating their enthusiasm for the study gel (13%), applicator (13%), and the effect of the gel on sexual pleasure (13%). In general, women who were untruthful had actually used the gel with condoms less and used the gel alone more than they had reported during the trial. Women overwhelmingly found the computer survey easy. Conclusion Researchers cannot assume that participants always tell the truth about sensitive behaviors in face-to-face interviews. ACASI was efficient and acceptable in this population.

The Impact of Questionnaire Administration Mode on Response Rate and Reporting of Consensual and Nonconsensual Sexual Behavior

Computer-administered self-interviewing (CASI) has been advocated as a way of overcoming underreporting of sensitive sexual behaviors. The present study compared reports of consensual and nonconsensual sexual behaviors (including childhood and adulthood sexual victimization) among women using CASI ( n = 1014) versus a self-administered questionnaire (SAQ; n = 318). Women, ages 18-30 years old, were recruited through random-digit dialing in the community. Response rates were significantly higher for the SAQ, which was sent and returned by mail (87.6% of those eligible), than for the CASI, which involved in-person assessment at a central location (61.4%). There were a few modest differences in reports of consensual or nonconsensual sexual behavior according to mode of administration, suggesting greater willingness to report sexual experiences among the SAQ sample. Mailed SAQ following telephone contact and with financial incentive may be a cost-effective way of obtaining data on sexual behavior from a community sample.

Increased reporting of male-to-male sexual activity in a national survey.

Prevention program designers need information on sexual behaviors to plan and evaluate their activities. Questions on sexual behavior have been added to a number of nationally representative interview surveys. The goal was to measure the percentage of adult men who have engaged in male-to-male sex in the past year and since age 18 years and to observe and interpret changes over time in these measurements. Data are from the General Social Survey, a nationally representative, household-based survey of adults conducted in 1988, 1989, 1990, 1991, 1993, 1994, 1996, 1998, and 2000. Questions on sexual behavior were part of a self-administered questionnaire completed by respondents. Estimates of male-to-male sex in the past year and since age 18 years were computed. Estimates of male-to-male sex in the past year were higher for surveys conducted beginning in 1996 (3.1%-3.7% compared with 1.7%-2.0% for earlier surveys), a difference that remains statistically significant when controlling for background factors associated with nonresponse. These estimates are also higher than observed from other similar surveys. The estimates are affected by high level of missing data and an unknown level of underreporting. Previous estimates of the size of this population subgroup based on survey research may be too low. Methods that increase survey respondents' sense of privacy and improve completeness of data collection are needed to improve quality of measurement of sensitive sexual behaviors.

A controlled randomized response technique.

The randomized response survey technique appears to be suitable for studies of sensitive sexual behaviors, particularly in AIDS-related research. However, existing methods provide only estimates of group statistics, not of individual information. Additionally, the popular "unrelated question" approach requires the knowledge of the parameters of the unrelated question. In this article, a variation of the unrelated-question method is suggested for use. Specifically, it is suggested that the unrelated question be one to which the response is known to be "yes." Through this "controlled" approach, the raw data become a direct linear transformation of the response to the sensitive question, and thus can be used directly in regression and other analyses at the individual score level. The estimation of the parameters for the unrelated question is not necessary and the hesitation to provide a "yes" response found in the "forced choice" method is minimized.

Bayesian non-randomized response models for surveys with sensitive questions

Three non-randomized response (NRR) models (namely, the non-randomized triangular, crosswise and hidden sensitivity models) have recently been developed for analyzing dichotomous sensitive questions. Unlike existing randomized response (RR) models, no randomizing device is required for NRR models. This helps to reduce the cost, increase the efficiency, ensure the reproducibility, widen the applicability and encourage the cooperation. However, in applications (e.g., estimating the proportion of a rare sensitive attribute in a population) with highly skewed likelihood functions, classical asymptotic methods based on maximum likelihood estimates and their asymptotic standard errors may not be adequate. The purposes of this article are two folds. First, we develop Bayesian approaches for analyzing dichotomous sensitive questions based on the aforementioned NRR models. For both the non-randomized triangular and crosswise models, we obtain the exact posterior distribution and its explicit posterior moments, derive posterior mode via the EM algorithm and provide procedure for generating i.i.d. posterior samples. For the hidden sensitivity model, we consider Bayesian analysis under the commonly used conjugate Dirichlet prior. Second, noting that the covariance structure associated with the Dirichlet distribution is completely nonpositive, we propose three new joint priors for modeling independence structure with restrictions, negative correlation structure and positive correlation structure, respectively. A new hierarchical modeling strategy is provided. Importance sampling and data augmentation algorithm are employed to compute posterior moments and generate posterior samples. Three data sets from a sensitive sexual behavior study, an induced abortion study and a HIV study are used to illustrate the proposed methodologies.