Interpreting sexual behaviour data:: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities
Interpreting sexual behaviour data:: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities
复制标题
DOI：
10.1097/00002030-200108004-00013
复制
发表时间：
2001-08-01
期刊：
影响因子：
3.8
通讯作者：
Sukwa, T
中科院分区：
文献类型：
--
作者：
Buvé, A;Lagarde, E;Sukwa, T
背景资料：关于决定非洲四个城市艾滋病毒不同传播的因素的多中心研究的主要结论是，性行为的不同本身不能解释四个城市之间艾滋病毒流行率的不同。本文件审查了可能使这一结论无效的三个潜在的偏见来源：（1）自艾滋病毒流行开始以来性行为的变化;（2）由于男子答复率低而产生的偏见;（3）报告的性行为中的偏见。为了评估随着时间的推移性行为是否有任何变化，对四个城市不同年龄组的性行为的选定参数进行了比较。由于雅温得、基苏木和恩多拉的男性未参与调查而导致的最大可能偏倚程度通过模拟练习进行评估，其中未参与调查的记录被替换为雅温得的“低活动男性”记录和基苏穆和恩多拉的“高活动男性”记录。为了评估性行为数据的有效性，进行了内部有效性检查：将性传播感染的生物数据与报告进行比较;将配偶的报告进行比较;将男女报告的性伴侣人数进行比较。第四种方法包括比较多中心研究的结果与外部来源，人口和健康调查（DHS）。结果：在所有四个城市的年轻人和老年人之间的性行为有差异，但没有证据表明转向安全的性行为在艾滋病毒高流行率的城市。在对雅温得、基苏木和恩多拉的男性非参与者进行模拟后，雅温得、基苏穆和恩多拉一生中的性伴侣人数中位数相似。通过对15-24岁的男性和女性进行各种性传播感染的检测，我们可以确定，在所有四个城市中，至少有1-9%的男性和6-18%的女性误报了他们的性活动。正如其他研究所发现的那样，在过去12个月里，男性报告的非配偶伴侣人数比女性报告的人数高出两到三倍。我们的调查和DHS之间最一致的差异是在过去12个月内从未结婚的男性和女性报告的非配偶伴侣的数量。在所有四个城市，参与者报告更多的非配偶的合作伙伴在DHS比在我们的survey.Conclusions：在所有四个城市，我们发现的证据表明，男性以及女性误报他们的性行为，但总体而言，似乎报告不足的性活动是不是更常见或更严重的两个高艾滋病毒流行率的城市比在两个低艾滋病毒流行率的城市。我们认为，多中心研究的主要结论仍然有效。(C)2001年利平科特威廉姆斯&威尔金斯。
Background: 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.Methods: 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).Results: 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.Conclusions: 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. (C) 2001 Lippincott Williams & Wilkins.