Accuracy of HIV-related risk behaviors reported by female sex workers, Iran: a method to quantify measurement bias in marginalized populations

AIDS Behav. 2013 Feb;17(2):623-31. doi: 10.1007/s10461-012-0285-z.


We quantified discrepancies in reported behaviors of female sex workers (FSW) by comparing 63 face-to-face interviews (FTFI) to in-depth interviews (IDI), with corroboration of the directions and magnitudes of reporting by a panel of psychologists who work with FSW. Sensitivities, specificities, positive and negative predictive values (PPV and NPV) were assessed for FTFI responses using IDI as a "gold standard". Sensitivities were lowest in reporting symptoms of sexually transmitted infections (63.9 %), finding sex partners in venues (52.4 %) and not receiving HIV test results (66.7 %). Specificities (all >83 %) and PPVs (all >74.0 %) were higher than NPV. FSW significantly under-reported number of clients, sexual contacts and non-condom use sex acts with clients and number of days engaging in sex work in the preceding week. This study provides a quantified gauge of reporting biases in FSW behaviors. Such estimates and methods help better understand true HIV risk in marginalized populations and calibrate survey estimates accordingly.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bias
  • Condoms / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • HIV Infections / psychology
  • Humans
  • Interviews as Topic
  • Iran / epidemiology
  • Middle Aged
  • Reproducibility of Results
  • Risk Factors
  • Risk-Taking
  • Sex Workers / psychology
  • Sex Workers / statistics & numerical data*
  • Sexual Behavior / psychology
  • Sexual Behavior / statistics & numerical data*
  • Sexual Partners* / psychology
  • Social Marginalization* / psychology
  • Social Stigma
  • Surveys and Questionnaires