Reliability of Sexual Behavior Self-Reports in Male Couples of Discordant HIV Status
Carballo-Dieguez, Alex, Remien, Robert H., Dolezal, Curtis, Wagner, Glenn, The Journal of Sex Research
Given the presence of strong cultural taboos against the direct observation of people's sexual activities, most sex researchers rely heavily on self-reports (Catania et al., 1993). Therefore, the reliability of these measures is of crucial importance. Attempts to assess reliability have involved contrasting long- and short-term behavioral recalls (Kauth, St. Lawrence, & Kelly, 1991; McElrath, Chitwood, Griffin, & Comerford, 1994;), comparing testretest results (Mahler, Hull, Stebinger, Perry, & Frances, 1995; McKinnon et al., 1993; Saltzman, Stoddard, McCusker, Moon, & Mayer, 1987; Weatherburn, Hunt, Davies, Coxon, & McManus, 1991), and checking the congruence of data obtained by different procedures (Boekeloo et al., 1994; James, Bignell, & Gillies, 1991; Siegel, Krauss, & Karus, 1994; Weatherbum et al., 1991) --including relating reported frequency of condom use and presence of STDs (Zenilman et al., 1995) and comparing the separate reports of primary partners (Coates et al., 1986; Darke, Hall, Heather, Ward, & Wodak, 1991; Jacobson & Moore, 1981; Kinsey, Pomeroy & Martin, 1948; Kinsey, Pomeroy, Martin, & Gebhard, 1953; Levinger, 1966; Padian, 1990; Seage, Mayer, Horsburgh, Cai, & Lamb, 1992; Upchurch et al., 1991). The results of these studies have been mixed, some finding that the self-reports were reliable and others that they were not. Overall, the studies highlighted the influence of methodological and respondent variables on reliability (for a thorough review of methodological problems in sexual behavior studies see Catania, Gibson, Chitwood, & Coates, 1990, and Catania, Kegeles, & Coates, 1990.). Finally, some authors have altogether criticized quantitative investigations of sexual behavior and have advocated, instead, for qualitative inquiries (Parker & Carballo, 1990).
If sexual matters are frequently shrouded in secrecy, sexual behavior that carries the potential of HIV transmission is likely to be even more concealed. It may be particularly difficult for people in HIV serodiscordant relationships (where one partner is HIV-positive and the other HIV-negative) to report high risk behavior given the social pressure to avoid such acts. Reliable and valid assessments of HIV-risk behaviors are critical to identify specific populations in need of intervention and to test the efficacy of any prevention program. Since no measure can be valid if not reliable, and given the absence of any published reliability study focusing specifically on HIV serodiscordant male couples, we saw a need to fill in this gap.
We had the rare opportunity of working with a group of 75 HIV-discordant male couples. We thoroughly explored the reliability of the reports the couples' members made of their behavior with each other in two ways: (a) We compared self-report to partner's report of anal sex, and (b) we analyzed the test-retest reliability of individual reports collected with a one-week interval.
Study participants were recruited in the New York Metropolitan area through leaflets distributed at gay organizations (HIV support groups, recreational clubs, etc.), advertisements in gay and AIDS-related newsletters and magazines, and by word of mouth. The eligibility criteria were (a) 18 years or older, (b) involved in a relationship with another man for at least four months, and (c) one partner being HIV-positive and the other one HIV-negative. A total of 75 male couples who fulfilled the eligibility criteria participated in the study. The participants' mean age was 36 years (SD = 8; range 22 - 66), their average education 15 years (SD = 3; range 9 - 20), and their mean annual income $37,300. Their racial/ethnic distribution was 63% Caucasian, 16% African American, and 21% Latino.
The assessment was divided in two parts: individual and joint (couple) assessment. The individual part consisted of an interviewer-administered section, which included the Sexual Practices Assessment Schedule - Couples version [SPAS-C] (Carballo-Dieguez, Exner, Gruen, & Meyer-Bahlburg, 1994; available from the first author), and a self-administered section. …