Condom use as a dependent variable: measurement issues relevant to HIV prevention programs

AIDS Educ Prev. 1998 Dec;10(6):548-57.


The value of condoms in efforts to slow the spread of HIV infection has been well established in the literature. Behavioral science faces the challenge of promoting condom use through intervention programs. As these programs are evaluated, multiple issues should be considered in relation to measuring participant use of condoms for the purposes of preventing HIV infection. Lack of attention to these issues is likely to create a large number of Type I and Type II errors. Ten common sources of error are described and corresponding recommendations for eliminating these errors are offered. A review of published studies shows that there is little consistency relevant to controlling for these sources of error. Incorporation of standardized methodology will allow for more accurate program evaluation and benefit researchers by facilitating comparisons across studies.

PIP: Condom promotion remains the primary method of HIV prevention for sexually active couples. Measurement of condom use--essential for the evaluation of AIDS prevention programs--is impeded, however, by factors such as self-report bias, participation bias, test-retest reliability problems, social desirability responses, and memory error. Standardized methodology in studies where condom use is the dependent variable would allow for more accurate calculation of effect size and enable application of meta-analytical tools needed to avoid Type II errors. Recommended, to improve measurement of condom use, are the following: 1) separate measurement of condom use for receptive and insertive partners; 2) consideration of the multiple contingencies that exist for a participant to adopt long-term condom use for HIV prevention; 3) recognition that the person must be able to negotiate within the confines of competing threats to survival (e.g., violent reprisals); 4) use of intent to conceive a child as a covariate; 5) requirement that the person is motivated by the threat of HIV rather than by pregnancy prevention or prevention of the spread of an existing STD; 6) determination of the participation of the sex partners in the decision to use condoms for HIV prevention; 7) account for temporal factors such as depression or alcohol intoxication; 8) measurement of condom use data in the form of ratio rather than interval data; 9) quantification of acts of unprotected sex rather than proportion of condom use; and 10) where possible, use of a within-subject design for evaluation of the treatment effect.

Publication types

  • Review

MeSH terms

  • Bias
  • Condoms / statistics & numerical data*
  • Female
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • HIV-1*
  • Humans
  • Male
  • Program Evaluation / methods
  • Program Evaluation / statistics & numerical data
  • United States