Measuring condom use: asking "do you or don't you" isn't enough

Area of Science:

• Public Health
• Epidemiology
• Social Sciences

Background:

• Accurate measurement of condom use is crucial for understanding sexual behavior and preventing sexually transmitted infections (STIs).
• Female sex workers are a key population for HIV/STI prevention efforts, making reliable data on their condom use essential.
• Previous research indicates that survey methodology can influence self-reported behaviors.

Purpose of the Study:

• To compare different cross-sectional survey measures of condom use among female sex workers in Cameroon.
• To assess how variations in questionnaire design affect reported condom use prevalence and consistency.
• To identify which measurement methods best capture condom use patterns in this population.

Main Methods:

• A randomized study involving 2,269 female sex workers in Cameroon.
• Participants were assigned to one of five different questionnaires to measure condom use.
• Data were collected using methods such as 2-week coital logs, past 10 acts, and always-to-never scales.

Main Results:

• Reported condom use levels varied significantly based on the questionnaire type used.
• Measures like 2-week coital logs and past 10 acts classified more women as "100%" or "0%" condom users compared to always-to-never scales.
• Condom use consistency also differed based on the type of sexual partner, though internal consistency of responses was high.

Conclusions:

• The choice of survey instrument significantly influences the reported prevalence and patterns of condom use among female sex workers.
• Future research should explore prospective measures and their correlation with STI incidence to validate current assessment tools.
• Standardizing condom use measurement is vital for accurate epidemiological surveillance and effective intervention design in sexual health programs.