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American Journal of Epidemiology Advance Access originally published online on September 9, 2009
American Journal of Epidemiology 2009 170(7):918-924; doi:10.1093/aje/kwp219
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Biomarker Validation of Reports of Recent Sexual Activity: Results of a Randomized Controlled Study in Zimbabwe

Alexandra M. Minnis, Markus J. Steiner, Maria F. Gallo, Lee Warner, Marcia M. Hobbs, Ariane van der Straten, Tsungai Chipato, Maurizio Macaluso and Nancy S. Padian

Correspondence to Dr. Alexandra Minnis, Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94104 (e-mail: aminnis{at}rti.org).

Received for publication April 10, 2009. Accepted for publication June 25, 2009.

Challenges in the accurate measurement of sexual behavior in human immunodeficiency virus (HIV) prevention research are well documented and have prompted discussion about whether valid assessments are possible. Audio computer-assisted self-interviewing (ACASI) may increase the validity of self-reported behavioral data. In 2006–2007, Zimbabwean women participated in a randomized, cross-sectional study that compared self-reports of recent vaginal sex and condom use collected through ACASI or face-to-face interviewing (FTFI) with a validated objective biomarker of recent semen exposure (prostate-specific antigen (PSA) levels). Of 910 study participants, 196 (21.5%) tested positive for PSA, an indication of semen exposure during the previous 2 days. Of these 196 participants, 23 (11.7%) reported no sex in the previous 2 days, with no difference in reported sexual activity between interview modes (12.5% ACASI vs. 10.9% FTFI; Fisher's exact test: P = 0.72). In addition, 71 PSA-positive participants (36.2%) reported condom-protected vaginal sex only; their reports also indicated no difference between interview modes (33.7% ACASI vs. 39.1% FTFI; P = 0.26). Only 52% of PSA-positive participants reported unprotected sex during the previous 2 days. Self-report was a poor predictor of recent sexual activity and condom use in this study, regardless of interview mode, providing evidence that such data should be interpreted cautiously.

biological markers; condoms; data collection; epidemiologic measurements; HIV; prostate-specific antigen; sexual behavior

Abbreviations: ACASI, audio computer-assisted self-interviewing; FTFI, face-to-face interviewing; HIV, human immunodeficiency virus; MIRA, Methods for Improving Reproductive Health in Africa; PSA, prostate-specific antigen


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