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. 2019 Jan 9;6(2):ofz010.
doi: 10.1093/ofid/ofz010. eCollection 2019 Feb.

Biological Validation of Self-Reported Unprotected Sex and Comparison of Underreporting Over Two Different Recall Periods Among Female Sex Workers in Benin

Katia Giguère  1   2 , Luc Béhanzin  1   3   4 , Fernand A Guédou  1   3 , François A Leblond  5 , Ella Goma-Matsétsé  3 , Djimon M Zannou  6   7 , Dissou Affolabi  6 , René K Kêkê  8 , Flore Gangbo  6   7   8 , Moussa Bachabi  8 , Michel Alary  1   2   9
Affiliations

Biological Validation of Self-Reported Unprotected Sex and Comparison of Underreporting Over Two Different Recall Periods Among Female Sex Workers in Benin

Katia Giguère et al. Open Forum Infect Dis. .

Abstract

Background: Self-reported unprotected sex validity is questionable and is thought to decline with longer recall periods. We used biomarkers of semen to validate self-reported unprotected sex and to compare underreporting of unprotected sex between 2 recall periods among female sex workers (FSW).

Methods: At baseline of an early antiretroviral therapy and pre-exposure prophylaxis demonstration study conducted among FSW in Cotonou, Benin, unprotected sex was assessed with retrospective questionnaires, and with vaginal detection of prostate-specific antigen (PSA) and Y-chromosomal deoxyribonucleic acid (Yc-DNA). Underreporting in the last 2 or 14 days was defined as having reported no unprotected sex in the recall period while testing positive for PSA or Yc-DNA, respectively. Log-binomial regression was used to compare underreporting over the 2 recall periods.

Results: Unprotected sex prevalence among 334 participants was 25.8% (50.3%) according to self-report in the last 2 (or 14) days, 32.0% according to PSA, and 44.3% according to Yc-DNA. The proportion of participants underreporting unprotected sex was similar when considering the last 2 (18.9%) or 14 days (21.0%; proportion ratio = 0.90; 95% confidence interval, 0.72-1.13). Among the 107 participants who tested positive for PSA, 19 (17.8%) tested negative for Yc-DNA.

Conclusions: Underreporting of unprotected sex was high among FSW but did not seem to be influenced by the recall period length. Reasons for discrepancies between PSA and Yc-DNA detection, where women tested positive for PSA but negative for Yc-DNA, should be further investigated.

Keywords: Y-chromosomal DNA; female sex workers; misreporting; prostate-specific antigen; sexual behavior.

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