Exploring Discordance Between Biologic and Self-Reported Measures of Semen Exposure: A Qualitative Study Among Female Patients Attending an STI Clinic in Jamaica

Abstract

Correspondence to: Marion W. Carter, acq0@cdc.gov. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptWe explored the use of qualitative interviews to discuss discrepancies between two sources of information on unprotected sex: biomarker results and self-reported survey data. The study context was a randomized trial in Kingston, Jamaica examining the effect of STI counseling messages on recent sexual behavior using prostate-specific antigen (PSA) as the primary study outcome. Twenty women were interviewed. Eleven participants were selected because they tested positive for PSA indicating recent semen exposure, yet reported no unprotected sex in a quantitative survey ("discordant"): 5 reported abstinence and 6 reported condom use. Nine participants who also tested positive for PSA but reported unprotected sex in the survey were interviewed for comparison ("concordant"). Qualitative interviews with 6 of the 11 discordant participants provided possible explanations for their PSA test results, and 5 of those were prompted by direct discussion of those results. Rapid PSA testing combined with qualitative interviews provides a novel tool for investigating and complementing self-reported sexual behavior.

Differences in Misreporting of Sexual Behavior Over Time

“…As previously revealed in a qualitative study conducted among a subset of the participants informed about their PSA positivity (following rapid testing at follow up), this social desirability bias may have prevented women from reporting failure to adhere to clinic staff’s instructions. 11 In contrast, at enrollment, women were asked to report on their behaviors, including unprotected sex, before any counseling messages were provided. Whether misreporting would have regressed to baseline levels (from participants becoming desensitized to counseling messages) or would have increased (from effect of cumulative messages) had our trial been longer is unknown.…”

Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women

“…Misreport of UVS among women living with HIV/AIDS hampers efforts to decrease sexual transmission of HIV by masking the intervention effects of condom promotion interventions and interfering with the interpretation of study findings related to condom use. Similar to the work conducted by the VOICE study team [20] and work with PSA among women in Jamaica [21], our results would benefit from follow-up qualitative interviews to uncover the reasons for misreported unprotected sex, and to determine correlates of misreport. Continued research on sexual risk behavior should incorporate semen biomarkers such as PSA as an adjunct to self-reported condom use.…”

The Use of Biomarkers of Semen Exposure in Sexual and Reproductive Health Studies

“…27 In addition to reporting bias, sometimes participants are unaware of their exposure. 15,22 Participants in clinical trials evaluating barrier methods of contraception, for example, may not be aware of some exposures such as a condom slippage or breakage that results in small exposures to semen. 22,27 By contrast, some participants may report that they had an exposure or experienced issues with the condom, when the use of biomarkers yields negative results for semen exposure.…”

“…8-23 Yc-DNA has also been used in studies evaluating self-reported condom use of adolescents. 10 PSA has been used to validate self-reports of recent sexual activity, 10-20 including among female participants receiving treatment for STIs advised to avoid sex (or unprotected sex), 14-15 and as an indicator of condom nonuse or failure. 4-11,14,15,21 …”