Validity of self-reported 'safe sex' among female sex workers in Mombasa, Kenya—PSA analysis

Gallo, Maria; Behets, Frieda; Steiner, Markus J.; Thomsen, Sarah; Ombidi, Wilkister; Luchters, Stanley; Toroitich‐Ruto, Cathy; Hobbs, Marcia M.

doi:10.1258/095646207779949899

Cited by 73 publications

(49 citation statements)

References 27 publications

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“…A revised calculation of unmet need which includes inconsistent (no condom use at last sex) condom users resulted in a greater (almost quadrupled) level of unmet need in this population. This revised estimate may not be entirely exact and hence may neither precisely reflect actual behaviour nor correct for potential response biases (a difficulty inherent in sexual behaviour research [13][14][15] ). Yet, it does reflect the importance of considering the correct and consistent use of condoms when describing the contraceptive needs of this population.…”

Section: Discussionmentioning

confidence: 99%

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Sutherland

Alaii²,

Tsui

et al. 2011

The European Journal of Contraception & Reproductive Health

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A B S T R A C TBackground and objectives Female sex workers (FSWs) are thought to be at heightened risk for unintended pregnancy, although sexual and reproductive health interventions reaching these populations are typically focused on the increased risk of sexually transmitted infections. The objective of this study of FSWs in Kenya is to document patterns of contraceptive use and unmet need for contraception. Methods This research surveys a large sample of female sex workers (N ¼ 597) and also uses qualitative data from focus group discussions. Results The reported level of modern contraceptives in our setting was very high. However, like in other studies, we found a great reliance on male condoms, coupled with inconsistent use at last sex, which resulted in a higher potential for unmet need for contraception than the elevated levels of modern contraceptives might suggest. Dual method use was also frequently encountered in this population and the benefits of this practice were clearly outlined by focus group participants. Conclusion These findings suggest that the promotion of dual methods among this population could help meet the broader reproductive health needs of FSWs. Furthermore, this research underscores the necessity of considering consistency of condom use when estimating the unmet or undermet contraceptive needs of this population.

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Section: Discussionmentioning

confidence: 99%

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Sutherland

Alaii²,

Tsui

et al. 2011

The European Journal of Contraception & Reproductive Health

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“…Previously conducted studies [2][3][4]7,[12][13][14][15][16] have typically employed only a single PSA assay. Our findings indicated a remarkable consistency of biomarker results regarding the presence or absence of semen exposure across the three PSA assays.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies that have compared PSA measurement with self-reported condom use and use problems suggest that PSA provides a more complete measure of condom failure during vaginal intercourse [13][14][15][16]. Methods for measuring PSA, however, vary in characteristics, performance and cost, and their comparability with respect to assessing condom performance has not been adequately evaluated.…”

Section: Introductionmentioning

confidence: 99%

Prostate-specific antigen as a biomarker of condom failure: comparison of three laboratory assays and self-reported condom use problems in a randomized trial of female condom performance

et al. 2012

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Background-Prostate-specific antigen (PSA), a biomarker for semen exposure, may provide a more objective measure of condom failure than subject self-reports. Methods for measuring PSA vary and their comparability with respect to assessing condom performance has not been adequately evaluated. This study compared results from three different PSA assays of vaginal samples collected by subjects in a randomized clinical trial which compared the performance of female condoms.Study Design-We selected 30 pairs of pre-and post-coital vaginal samples from subjects who reported condom functionality problems or whose original PSA assay was positive. Samples were retested using three different PSA assays [quantitative enzyme-linked immunoassay (EIA), rocket immune-electrophoresis (RIE) and chromatographic immunoassay (CIA)]. We compared the proportion of condom uses where the post-coital PSA result indicated semen exposure for each of the three assays.Results-Despite varying levels of sensitivity, the results from all three assays were remarkably consistent. Self-reported condom failures did not correlate well with positive PSA results, suggesting that exclusive reliance on either PSA or user self-report may be inadequate for assessing condom functionality. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusion-In combination with user self-report of condom failure, PSA testing provides a reliable, objective marker of condom functionality. Studies based on PSA testing may improve on conventional contraceptive clinical trials by offering a more direct assessment of a condom product's ability to prevent semen exposure.

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“…While the reasons for misreporting in surveys are well-known (e.g., social desirability bias, recall bias), efforts to identify who is more likely to have discrepancies between self-reported survey data and biomarkers, including PSA, have had little success [12,[19][20][21]. In this study, we found that for several women in Group C (concordant), partner influences played a dominant role in their account of why they had unprotected sex, unlike women in Groups A and B (discordant).…”

Section: Discussionmentioning

confidence: 99%

“…However, studies also show that PSA degrades rapidly in the vagina, returning to baseline levels in 24-48 h after exposure [18]. Studies comparing PSA test results with self-reported sexual behaviors have identified high levels of discordance between the two, confirming concerns about the under-reporting of unprotected sexual activity and over-reporting of condom use [7,[19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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

Carter¹,

Bailey

Snead³

et al. 2012

AIDS Behav

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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.

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Validity of self-reported 'safe sex' among female sex workers in Mombasa, Kenya—PSA analysis

Cited by 73 publications

References 27 publications

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Prostate-specific antigen as a biomarker of condom failure: comparison of three laboratory assays and self-reported condom use problems in a randomized trial of female condom performance

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

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