Series editors J M Stephenson, A Babiker

The study of sexual behaviour lies at the heart of understanding the transmission dynamics of sexually transmitted infections (STIs). Academic investigation into sexual behaviour dates back to the 18th century and, over time, has employed a variety of approaches including the medical and psychiatric investigation of sexual disorders, anthropological investigations, and survey research based largely on volunteer samples. More recent studies, driven largely by the public health response to HIV/AIDS, have focused on large scale probability sample survey research.1–5 Key areas of inquiry have shifted towards describing population patterns of risk behaviours for STI/HIV transmission, understanding how epidemics of STIs are generated, and informing disease control strategies.

Sexual behaviour is a largely private activity, subject to varying degrees of social, cultural, religious, moral and legal norms and constraints. A key challenge for all sex survey research is to generate unbiased and precise measures of individual and population behaviour patterns. Methods are needed to minimise measurement error which may be introduced by participation bias, recall and comprehension problems, and respondents' willingness to report sensitive and sometimes socially censured attitudes or behaviours.6, 7 This paper briefly considers the role of different types of study in understanding STI epidemiology. It then focuses on potential sources of measurement error in survey research and strategies for assessing and limiting them.Sex Transm Inf 2001;77:84–92

The type of study chosen will depend on the purpose of the investigation. However, studies generally fall into four main groups: general population surveys, studies on population subgroups, partner and network studies, ethnographic and qualitative studies.

### GENERAL POPULATION PROBABILITY SAMPLE SURVEYS

Cross sectional population surveys aim to describe the overall distribution of behaviours in populations. By using probability sampling techniques and maximising response rates, large scale behavioural surveys can provide robust estimates of the prevalence …

https://sti.bmj.com/content/sextrans/77/2/84.full.pdf

Measuring sexual behaviour: methodological challenges in survey research

THE EPIDEMIC of acquired immunodeficiency syndrome (AIDS) epidemic is an unprecedented public health threat; it constitutes the leading cause of premature mortality in some areas of the United States, and it is growing rapidly 1 Until a cure is developed, the only way to control the epidemic is through prevention strategies directed at the three modes of spread of infection with the human immunodeficiency virus (HIV) Preventing spread of infection by infusion or inoculation of blood involves making blood products safe and teaching intravenous drug users how to avoid infection Preventing the perinatal spread of infection to newborn babies involves testing prospective mothers for HIV antibodies and advising those who test positive to avoid pregnancy or, if already pregnant, to consider abortion In this report we consider strategies for controlling the third and most common mode of spread, sexual contact  A recent report by Friedland and Klein 2 recommends educating

https://jamanetwork.com/journals/JAMA/articlepdf/371700/jama_259_16_029.pdf

Preventing the Heterosexual Spread of AIDS: Are We Giving Our Patients the Best Advice?

We are a testing culture: we test our urine for drugs; we test our sweat for lies. It is not surprising that we should also test our blood for the acquired immunodeficiency syndrome (AIDS). But bef...

Screening for HIV: can we afford the false positive rate?

An improved prognostic staging system is needed for patients with the acquired immunodeficiency syndrome (AIDS). To construct such a system, we analyzed the course of 117 consecutive adults who received a diagnosis of AIDS at Yale–New Haven Hospital from 1981 through 1987. The staging system was developed from the data on the first 76 patients, confirmed in the remaining 41 patients, and then applied to the entire cohort. The staging system, which is based on physiologic deficits rather than demographic or diagnostic features, gives one point for each of the following: severe diarrhea or serum albumin level under 2.0 g per deciliter, any neurologic deficit, arterial oxygen tension of 50 mm Hg or less, hematocrit below 30 percent, lymphocyte count below 150 per microliter, white-cell count below 2500, and platelet count below 140,000. The total score determines the presence of Stages I (0 points), II (1 point), or III (2 to 7 points). The three stages had distinctive prognostic gradients in our co...

A new prognostic staging system for the acquired immunodeficiency syndrome.

Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.

AIDS and heterosexual anal intercourse

The Walter Reed staging classification in the follow-up of HIV infection.

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The Walter Reed staging classification in the follow-up of HIV infection.