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Interpreting sexual behaviour data: validity issues in the
multicentre study on factors determining the differential spread
of HIV in four African cities
Buve, A | Lagarde, E | Caraeel, M | Rutenberg, N | Ferry, B | Glynn,
JR | Laourou, M | Akam, E | Chege, J | Sukwa, T
AIDS [AIDS]. Vol. 15, suppl. 4, pp. S117-S126. Aug 2001.
The main conclusion of the multicentre study on factors
determining the differential spread of HIV in four African cities
was that differences in sexual behaviour could not, by themselves,
explain the differences in HIV prevalence between the four cities.
The present paper examines three potential sources of bias that
could invalidate this conclusion: (1) changes in sexual behaviour
since the start of the HIV epidemics; (2) bias due to the low
response rates of men; and (3) bias in reported sexual behaviour.
To assess whether there have been any changes in sexual behaviour
over time, selected parameters of sexual behaviour were compared
between different age groups in the four cities. The maximum
likely extent of bias due to non-participation of men in Yaounde,
Kisumu and Ndola was assessed with a simulation exercise, in which
records of non-participants were replaced with records of 'low
activity men' in Yaounde and 'high activity men' in Kisumu and
Ndola. To assess the validity of the sexual behaviour data,
internal validity checks were carried out: comparing biological
data on sexually transmitted infections with reports; comparing
reports of spouses; and comparing numbers of sex partners reported
by men and women. A fourth method consisted of comparing the
findings of the multicentre study with an external source,
Demographic and Health Surveys (DHS). There were differences in
sexual behaviour between the younger and the older age groups in
all four cities but there was no evidence of a shift towards safer
sexual behaviour in the high HIV prevalence cities. After
simulating results for male non-participants in Yaounde, Kisumu
and Ndola, the median lifetime number of sex partners was similar
in Yaounde, Kisumu and Ndola. By testing for various sexually
transmitted infections among men and women aged 15-24 years who
reported that they had never had sexual intercourse, we could
establish that, in all four cities, at least 1-9% of men and 6-18%
of women had misreported their sexual activity. The number of
non-spousal partners in the past 12 months reported by men was two
to three times higher than the number reported by women, as has
been found in other studies. The most consistent differences
between our survey and the DHS were found in the numbers of
non-spousal partners in the past 12 months reported by
never-married men and women. In all four cities, participants
reported more non-spousal partners in the DHS than in our survey.
In all four cities, we found evidence that men as well as women
misreported their sexual behaviour, but overall it seems that
under-reporting of sexual activity was not more common or more
serious in the two high HIV prevalence cities than in the two low
HIV prevalence cities. We believe that the main conclusions of the
multicentre study still hold.
 Descriptors: Article Subject Terms Acquired immune deficiency syndrome | Disease
transmission | Sexual behavior | Transmission (sexual) | Urban areas | Article Taxonomic Terms Human immunodeficiency virus | Article Geographic Terms Africa | Benin | Cameroon | Kenya | Zambia
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