Abstract
We analyzed biomarker validation data of unprotected sex from women in Zimbabwe to determine whether condom and sexual behavior misreporting differs between users of different contraceptive methods. Self-reported sexual behavior was compared with the presence of prostate-specific antigen (PSA) in vaginal fluid, a biomarker of semen exposure. Of the 195 women who were PSA positive, 94 (48 %) reported no sex or only condom-protected sex. Hormonal contraceptive users misreported sexual behavior less than women using non-hormonal methods (45 vs. 67 %, P = 0.03). This misclassification pattern could have implications on the elevated risk of HIV infection associated with hormonal contraception in some studies.
References
Morrison CS, Turner AN, Jones LB. Highly effective contraception and acquisition of HIV and other sexually transmitted infections. Best Pract Res. 2009;23(2):263–84.
McCoy SI, Zheng W, Montgomery E, et al. Oral and injectable contraception use and risk of HIV acquisition among women in the methods for improving reproductive health in Africa (MIRA) study. AIDS. 2012;27(6):1001–09.
Wand H, Ramjee G. The effects of injectable hormonal contraceptives on HIV seroconversion and on sexually transmitted infections. AIDS. 2012;26(3):375–80.
Heffron R, Donnell D, Rees H. et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2011;12(1):19–26.
Morrison CS, Chen PL, Kwok C, et al. Hormonal contraception and HIV acquisition: reanalysis using marginal structural modeling. AIDS. 2010;24(11):1778–81.
Crook A, Rees H, Ramjee G, et al. Hormonal Contraception and Risk of HIV: An Analysis of Data from the Microbicides Development Programme Trial. Paper presented at: 20th Conference on Retroviruses and Opportunistic Infections 2013; Atlanta, GA.
Polis CB, Curtis KM. Use of hormonal contraceptives and HIV acquisition in women: a systematic review of the epidemiological evidence. Lancet Infect Dis. 2013;13(9):797–808.
United Nations Department of Economic and Social Affairs. World Contraceptive Use 2011. 2011; Accessed January 24, 2012.
Singh S, Darroch JE. Adding it up: costs and benefits of contraceptive services. New York: Guttmacher Institute and United Nations Population Fund (UNFPA); 2012.
Department of Reproductive Health and Research. Hormonal contraception and HIV, Technical statement. Geneva: World Health Organization; 2012.
Polis C, Westreich D, Balkus JE, Heffron R. Participants of the 2013 HC–HIV observational analysis meeting. Assessing the effect of hormonal contraception on HIV acquisition in observational data: challenges and recommended analytic approaches. AIDS. 2013;27(Suppl 1):S35–43.
Warner P. Concerns regarding design, analysis, and interpretation of the morrison study on hormonal contraceptive use and acquisition of cervical infections. Sex Transm Dis. 2005;32(10):644 author reply 645.
Gray RH. Use of hormonal contraceptives and risk of HIV-1 transmission. Lancet Infect Dis. 2012;12(7):507 author reply 510-501.
Shelton JD. Use of hormonal contraceptives and risk of HIV-1 transmission. Lancet Infect Dis. 2012;12(7):507–8 author reply 510-501.
Hubacher D. Use of hormonal contraceptives and risk of HIV-1 transmission. Lancet Infect Dis. 2012;12(7):508 author reply 510-501.
Kleinschmidt I, Maggwa BN, Smit J, Beksinska ME, Rees H. Dual protection in sexually active women. S Afr Med J. 2003;93(11):854–7.
Morroni C, Smit J, McFadyen L, Mqhayt M, Beksinska M. Dual protection against sexually transmitted infections and pregnancy in South Africa. Afr J Reprod Health. 2003;7(2):13–9.
Morrison CS, Skoler-Karpoff S, Kwok C, et al. Hormonal contraception and the risk of HIV acquisition among women in South Africa. AIDS. 2011;26(4):497–504.
Watson-Jones D, Baisley K, Weiss HA, et al. Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania. AIDS. 2009;23(3):415–22.
Reid SE, Dai JY, Wang J, et al. Pregnancy, contraceptive use, and HIV acquisition in HPTN 039: relevance for HIV prevention trials among African women. J Acquir Immune Defic Syndr. 2010;53(5):606–13.
Feldblum PJ, Lie C, Weaver MA, et al. Baseline factors associated with incident HIV and STI in four microbicide trials. Sex Transm Dis. 2010;37(10):594–601.
Padian NS, van der Straten A, Ramjee G, et al. Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet. 2007;370(9583):251–61.
Minnis AM, Steiner MJ, Gallo MF, et al. Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe. Am J Epidemiol. 2009;170(7):918–24.
Macaluso M, Lawson L, Akers R, et al. Prostate-specific antigen in vaginal fluid as a biologic marker of condom failure. Contraception. 1999;59(3):195–201.
Minnis AM, van der Straten A, Gerdts C, Padian NS. A comparison of four condom-use measures in predicting pregnancy, cervical STI and HIV incidence among Zimbabwean women. Sex Transm Infect. 2010;86(3):231–5.
Gallo MF, Sobel JD, Rompalo AM, Cu-Uvin S, Schoenbaum E, Jamieson DJ. Discordance between spermatozoa detection and self-reported semen exposure. Sex Transm Dis. 2011;38(10):909–12.
Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1998.
Greenland S. The effect of misclassification in the presence of covariates. Am J Epidemiol. 1980;112(4):564–9.
Savitz DA, Baron AE. Estimating and correcting for confounder misclassification. Am J Epidemiol. 1989;129(5):1062–71.
Marshall JR, Hastrup JL. Mismeasurement and the resonance of strong confounders: uncorrelated errors. Am J Epidemiol. 1996;143(10):1069–78.
VanderWeele TJ, Valeri L, Ogburn EL. The role of measurement error and misclassification in mediation analysis: mediation and measurement error. Epidemiology. 2012;23(4):561–4.
le Cessie S, Debeij J, Rosendaal FR, Cannegieter SC, Vandenbroucke JP. Quantification of bias in direct effects estimates due to different types of measurement error in the mediator. Epidemiology. 2012;23(4):551–60.
Ogburn EL, VanderWeele TJ. Analytic results on the bias due to nondifferential misclassification of a binary mediator. Am J Epidemiol. 2012;176(6):555–61.
Smith J, Butler A, Polis C, Gregson S, Stanton D, Hallett T. Programmatic Implications: Balancing Maternal Mortality and HIV Risk. Paper presented at: 20th Conference on Retroviruses and Opportunistic Infections 2013; Atlanta, GA.
Morrison CS, Richardson BA, Mmiro F, et al. Hormonal contraception and the risk of HIV acquisition. AIDS. 2007;21(1):85–95.
Gallo MF, Steiner MJ, Hobbs MM, Warner L, Jamieson DJ, Macaluso M. Biological markers of sexual activity: tools for improving measurement in HIV/sexually transmitted infection prevention research. Sex Transm Dis. 2013;40(6):447–52.
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Dr. McCoy is supported by the National Institute of Mental Health at the National Institutes of Health (K01MH094246 to S.I.M.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.
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McCoy, S.I., Ralph, L.J., Padian, N.S. et al. Are Hormonal Contraceptive Users More Likely to Misreport Unprotected Sex? Evidence From a Biomarker Validation Study in Zimbabwe. AIDS Behav 18, 2259–2264 (2014). https://doi.org/10.1007/s10461-014-0741-z
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DOI: https://doi.org/10.1007/s10461-014-0741-z