The effect of interview method on self-reported sexual behavior and perceptions of community norms in Botswana

Experimental validation of specialized questioning techniques in conservation

Conservation increasingly relies on social science tools to understand human behavior. Specialized questioning techniques (SQTs) are a suite of methods designed to reduce bias in social surveys and are widely used to collect data on sensitive topics, including compliance with conservation rules. Most SQTs have been developed in Western, industrialized, educated, rich, and democratic countries, meaning their suitability in other contexts may be limited. Whether these techniques perform better than conventional direct questioning is important for those considering their use. We designed an experiment to validate the performance of four SQTs (unmatched count technique, randomized response technique, crosswise model, and bean method) against direct questions when asking about a commonly researched sensitive behavior in conservation, wildlife hunting. We developed fictional characters, and for each method asked respondents to report the answers that each fictional character should give when asked if they hunt wildlife. We collected data from 609 individuals living close to protected areas in two different cultural and socioeconomic contexts (Indonesia and Tanzania) to quantify the extent to which respondents understood and followed SQT instructions and to explore the sociodemographic factors that influenced a correct response. Data were modeled using binomial general linear mixed models. Participants were more likely to refuse to answer questions asked using SQTs compared with direct questions. Model results suggested that SQTs were harder for participants to understand. Demographic factors (e.g., age and education level) significantly influenced response accuracy. When sensitive responses to sensitive questions were required, all SQTs (excluding the bean method) outperformed direct questions, demonstrating that SQTs can successfully reduce sensitivity bias. However, when reviewing each method, most respondents (59-89%) reported they would feel uncomfortable using them to provide information on their own hunting behavior, highlighting the considerable challenge of encouraging truthful reporting on sensitive topics. Our results demonstrate the importance of assessing the suitability of social science methods prior to their implementation in conservation contexts.

Estimation of the Proportion of Potential Nondisclosed Men Who Have Sex With Men Among Self-Reported Heterosexual Men With HIV Using a Randomized Response Technique

BACKGROUND

Because of HIV-related stigma and gender minority stigma, the number of men who have sex with men (MSM) among registered HIV/AIDS cases may be underreported in Guangxi, China. In addition to the sensitivity of direct inquiry of sexual identity and behavior, our study aims to determine the proportion of potential nondisclosed MSM (pnMSM) among self-reported heterosexual men with HIV.

METHOD

The study subjects were self-reported heterosexual men with HIV who were diagnosed in recent 20 years in Guangxi, China. A randomized response technique was executed by randomly putting them to secretly answer either whether their birthday was odd or even day, or whether they experienced anal sex in the last 3 years. Personal characteristics were linked with randomized response technique answers for subgroup analysis.

RESULTS

The proportion of pnMSM ever having anal sex was estimated to be 14.3% in Guangxi, China. Being younger, having a college or above education level, single, employed, of Han ethnicity, diagnosed with HIV in the past 6 years, and not on antiretroviral therapy were associated with giving positive answer.

CONCLUSIONS

The reported number of MSM cases with HIV in the past may have been underestimated in Guangxi, China. Information about preexposure and postexposure prophylaxis should be provided to this stigmatized subgroup-pnMSM, especially those who are younger and with a higher socioeconomic status among self-reported heterosexual men with HIV.

The use of PSA as a biomarker of recent semen exposure in female reproductive health studies

Semen contains potent soluble proteins, bacteria, viruses, activated immune cells as well as anti- and pro-inflammatory cytokines that may influence the inflammatory response and alter microbial composition of the female genital tract. The presence of semen in the female genital mucosa may be a significant confounder that most studies have failed to control for in their analysis. Prostate-specific antigen (PSA), a protein secreted by the prostate into the urethra during ejaculation, is a well-established biomarker of semen exposure. Several studies have demonstrated discordance between self-reports of sexual behavior and the presence of PSA. Recent semen exposure has been shown to promote pro-inflammatory responses, stimulate the recruitment of activated immune cells and decrease Lactobacilli abundance in the female genital mucosa. As a result, it is important to understand the concordance between self-reported consistent condom use and the presence of semen biomarkers. Furthermore, to ensure that the interpretation of data in clinical studies of the immunological and microbial environment in the female genital mucosa are accurate, it is essential to establish whether semen is present in the vaginal fluid. This review explores the impact of semen exposure on the mucosal microenvironment and assesses the use of the PSA as an objective biomarker of semen exposure to reduce reliance on self-reported sexual intercourse.

The bean method as a tool to measure sensitive behavior

Conservationists need to measure human behavior to guide decisions and evaluate their impact. However, activities can be misreported and reporting accuracy may change following conservation interventions, making it hard to verify any apparent changes. Techniques for asking sensitive questions are increasingly integrated into survey designs to improve data quality, but some can be costly or hard for nonexperts to implement. We demonstrate a straightforward, low-cost approach, the bean method in which respondents give anonymous answers by adding a colored bean to a jar to denote a yes or no response. We applied the bean method to measure wild-meat hunting and trading over 2 years at a conservation-project (hunting reduction) site in Gola Forest, Liberia. We extended the technique to accommodate questions about hunting and meat-selling frequency. We compared responses given using the bean method and direct questioning for groups that did and did not participate in conservation interventions. Results from the bean method corresponded to those from direct questioning, and there was no indication of change in question sensitivity following conservation interventions. Estimates from both methods indicated that wild-meat trading decreased in project and nonproject households (from 36% to 20%) and that hunting decreased in 1 project group (38-28%). Where inconsistent answers were given (2-6% of respondents), differences were in both directions and were most likely attributable to measurement error. The bean method was quick and straightforward to administer in a low-literacy setting. We showed how it can be modified for answers of more than 2 categories and consider it a valuable tool that could be adapted for a wide range of conservation settings.

Migration and sexual partnerships among unmarried young men in Thailand: a longitudinal approach

OBJECTIVES

Migrants typically report more sexual behavior than non-migrants. In existing work, the potentially confounding effects of selection loom large. Our objective is to discern whether migrants actually do engage in more sexual activity than their non-migrating counterparts, once selection is accounted for.

METHODS

We used three waves of data from a longitudinal panel study in Thailand. Panel members were rural unmarried men, some of whom subsequently migrated to urban areas and were re-interviewed there. Migrants were compared to their non-migrant counterparts and to a separate sample of long-term urban dwellers.

RESULTS

There were no differences between eventual migrants and non-migrant counterparts in sexual partnerships before migration. Migration increased sexual partnerships with stable partners and strangers, compared with rural non-migrants.

CONCLUSIONS

Unmarried men who moved to urban areas had increased sexual partnerships with stable partners and strangers. Without proper means of protection, this pattern of behavior puts these men and their sexual partners at elevated risk of unwanted pregnancy and sexually transmitted infections (STIs). Public health programs should target unmarried male migrants for pregnancy control and STI prevention.

The relationship between interviewer-respondent familiarity and family planning outcomes in the Democratic Republic of Congo: a repeat cross-sectional analysis

OBJECTIVES

The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected family planning outcomes, and whether this relationship changes over time between 2015 and 2016.

SETTING

We use data from the Performance Monitoring and Accountability 2020 Project in Kongo Central Province, Democratic Republic of Congo.

PARTICIPANTS

Participants include representative samples of women of reproductive ages (15 to 49), 1565 interviewed in 2015 and 1668 in 2016. The study used a two-stage cluster design: first randomly selecting enumeration areas (EAs), then randomly selecting households within each EA.

DESIGN

We first identify individual characteristics associated with familiarity between RE and respondent. Next, we examine the relationship between RE-respondent acquaintance and family planning outcomes. Finally, we use two waves of data to examine whether this relationship changes over time between 2015 and 2016.

RESULTS

In multivariate analysis, interviewer-respondent acquaintance is significantly associated with last birth unintended (OR 1.91, 95% CI 1.17 to 3.13) and reported infertility in 2015 (OR 2.26, 95% CI 1.03 to 4.95); and any contraceptive use (OR 1.51, 95% CI 1.01 to 2.28), traditional contraceptive use (OR 1.79, 95% CI 1.10 to 2.89), reported infidelity (OR 1.89, 95% CI 1.02 to 3.49) and age at first sex (coefficient -0.48, 95% CI -0.96 to -0.01) in 2016. The impact of acquaintance on survey responses changed over time for any contraceptive use (OR 2.09, 95% CI 1.33 to 3.30).

CONCLUSIONS

The standard in many large-scale surveys is to use interviewers from outside the community. Our results show that interviewer-respondent acquaintance is associated with a range of family planning outcomes; therefore, we recommend that the approach to hiring interviewers be examined and reconsidered in survey data collection efforts.

Behavioral Risk Profile of Men Who Have Sex with Men in Beijing, China: Results from a Cross-sectional Survey with Randomized Response Techniques

Background:

Human immunodeficiency virus (HIV) is spreading rapidly among men who have sex with men (MSM) in China. Anonymous questionnaires or direct interviews have been frequently used to study their behavior. The aim of the study was to describe the behavioral risk profile of the MSM in Beijing using the randomized response techniques (RRTs).

Methods:

A cross-sectional survey of sexual behavior among a sample of MSM was conducted in two HIV counseling and testing clinics in Beijing. The survey was carried out with an anonymous questionnaire containing sensitive questions on sexual behavior. To obtain the honest responses to the sensitive questions, three distinctive RRTs were used in the questionnaire: (1) Additive randomized response model for quantitative questions, (2) randomized response model for multiple choice questions, and (3) Simmons randomized response model for binomial questions. Formulae for the point estimate, variance, and confidence interval (CI) were provided for each specific model.

Results:

Using RRTs in a sample of 659 participants, the mean age at first homosexual encounter was estimated to be 21.7 years (95% CI: 21.2–22.2), and each had sex with about three (2.9, 95% CI: 2.4–3.4) male partners on average in the past month. The estimated rate for consistent condom use was 56.4% (95% CI: 50.1–62.8%). In addition, condom was estimated to be used among 80.0% (95% CI: 74.1–85.9%) of the population during last anal sex with a male partner.

Conclusions:

Our study employed RRTs in a survey containing questions on sexual behavior among MSM, and the results showed that RRT might be a useful tool to obtain truthful feedback on sensitive information such as sexual behavior from the respondents, especially in traditional Chinese cultural settings.

Y chromosome and HIV DNA detection in vaginal swabs as biomarkers of semen and HIV exposure in women

BACKGROUND

The inability to quantify sexual exposure to HIV limits the power of HIV prevention trials of vaccines, microbicides, and preexposure prophylaxis in women. We investigated the detection of HIV-1 and Y chromosomal (Yc) DNA in vaginal swabs from 83 participants in the HPTN 035 microbicide trial as biomarkers of HIV exposure and unprotected sexual activity.

METHODS

One hundred forty-three vaginal swabs from 85 women were evaluated for the presence of Yc DNA (Quantifiler Duo DNA quantification kit; Applied Biosystems) and total HIV-1 DNA (single-copy in-house quantitative polymerase chain reaction assay). Y DNA detection was paired with self-reported behavioral data with regard to recent coitus (≤1 week before collection) and condom usage (100% vs. <100% compliance).

RESULTS

Yc DNA was detected in 62 (43%) of 143 swabs. For the 126 visits at which both behavioral data and swabs were collected, Yc DNA was significantly more frequent in women reporting less than 100% condom usage (odds ratio, 10.69; 95% confidence interval, 2.27-50.32; P = 0.003). Notably, 27 (33%) of 83 swabs from women reporting 100% condom usage were positive for Yc DNA. HIV DNA was only detected in swabs collected postseroconversion.

CONCLUSIONS

The use of Yc DNA in HIV prevention trials could reliably identify subgroups of women who have unprotected sexual activity and could provide valuable exposure-based estimates of efficacy.

Rural-to-urban migration and sexual debut in Thailand

Migration from one's parents' home and sexual debut are common features of the transition to adulthood. Although many studies have described both of these features independently, few have examined the relationship between migration and sexual debut in a systematic manner. In this study, we explore this link for young adults in Thailand. With relatively high rates of internal migration, rapid modernization, a moderate HIV epidemic, and a declining average age of sexual debut, Thailand presents an instructive environment in which to examine migration and sexual debut. We use two waves of a longitudinal data set (2005 and 2007) that includes a subsample of young adults who migrated to urban areas during that period. We identify characteristics and behaviors associated with sexual debut and examine the role of migration on debut. Our approach reduces several common sources of bias that hamper existing work on both migration and sexual debut: (1) the longitudinal nature of the data enables us to examine the effects of characteristics that predate both behaviors of interest; (2) the survey on sexual behavior employed a technique that reduces response bias; and (3) we examine differences in debut by marital status. We find that migrants have a higher likelihood of sexual debut than nonmigrants.