Sexual behaviors relevant to HIV transmission in a rural African population: How much can a KAP survey tell us?

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Abstract

KAP surveys have been proposed as a means to gather quantitative information on AIDS-related sexual behaviors, but the validity of survey results has not been tested. The validity of data gathered during a KAP survey in a rural district in Northern Uganda (N = 1486) was examined analyzing expected behavioral patterns, agreement of partner reports, and concordance of number of sexual contacts across gender. Patterns of sexual behavior and age trends are as expected. More men (50%) than women (18.5%) reported premarital sex. The likelihood of sexual intercourse before marriage increases with age at first marriage and with education. Women marry 5 years earlier than men, and the number of marriages increases with age. Peak incidence of casual sex occurs before age 25. The male/female ratio of casual sex is 4, as compared to about 3 in other African surveys. Single men are 2.5 times more likely to engage in casual sex than married males. Agreement of partner reports was examined for 392 couples selected by chance. 86% of the couples agreed on being polygamous or monogamous. On average men reported 1.3 (SD = 0.7) wives as compared to women reporting 1.5 (SD = 0.89) wives (P <0.001). 16.8% of women declared more, and 2.8% less cowives than their husband (r = 0.65). Self-reports on frequency of sexual intercourse in the past month were examined for 256 monogamous couples. Mean frequencies differ (5.24±5.1 for men, 4.43±4.7 for women, P<0.001). 42.8% of couples are in agreement within ±1 unit (r=0.44). The total number of extra-marital and marital sex acts, as well as the total number of partners reported by each gender are similar. There is, however, a striking gender difference in reporting of casual partners in the past year. Data were found to be accurate at the aggregate level. However, accuracy of reporting at the individual level was found to be low. The gender difference in reporting of casual partners may be due to female underreporting, to not having captured prostitutes or to a different perception of the meaning of casual partnership. All KAP surveys should include a validity analysis, so as to provide a sense of the accuracy of the surveys and allow for comparison of the quality of different KAP surveys. There is an urgent need for a standardized approach to validating the findings from AIDS-related KAP surveys. Some of the indirect methods described here could be relevant for further use.

References (38)

  • P. Van de Perre et al.

    Acquired immunodeficiency syndrome in Rwanda

    Lancet

    (1984)
  • P. Piot et al.

    Acquired immunodeficiency syndrome in a heterosexual population in Zaire

    Lancet

    (1984)
  • J.M. Mann et al.

    Surveillance for AIDS in a central African city, Zaire

    JAMA

    (1986)
  • P. Piot et al.

    Retrospective Seroepidemiology of AIDS virus infection in Nairobi populations

    J. Inf. Dis.

    (1987)
  • M. Carael et al.

    Human immunodeficiency virus transmission among heterosexual couples in Central Africa

    AIDS

    (1988)
  • L.A. Adeokun

    Research on human sexuality in pattern II countries

  • Caldwell C., Caldwell P. and Quiggin P. The social context of AIDS in sub-Saharan Africa. Pop. Dev. Rev. 15,...
  • P.M. Hauser

    Limitations of KAP surveys

  • D.P. Warwick

    The KAP survey: dictates versus demands of science

  • R.E. Mitchell

    Survey materials collected in developing countries: sampling, measurement and interviewing obstacles to intranational and international comparison

  • J.W. Ratcliffe

    Analyst biases in Kap surveys: a cross-cultural comparison

    Stud. Fam. Planning

    (1976)
  • Research Package: Knowledge, Attitudes, Beliefs and Practices on AIDS (KABP)

    (January 1990)
  • M. Carballo et al.

    Research agenda: a cross national study of patterns of sexual behavior

    J. Sex Res.

    (1989)
  • C. Caldwell et al.

    The social context of AIDS in sub-Saharan Africa

    Pop. Dev. Rev.

    (1989)
  • E.P.Y. Muhondwa

    Impertinent interviewers and lying respondents: a critique of the survey research method for heterosexual HIV transmission research in Africa

  • C. Enel et al.

    Sexual behavior in rural areas of Senegal: an example in Casamance

  • M. Hogsborg et al.

    Sexual relations, use of condoms and perceptions of AIDS in an urban area of Guinea-Bissau with a high prevelance of HIV-2

  • National AIDS Control Programme: National surveys of knowledge, attitudes, beliefs and practices on AIDS

    (1989)
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