Abstinence, lies and STDs: Assessing the validity of adolescents' self-report of abstinence

Background: Self-report behavior has been the cornerstone of measurement in HIV/STD and prevention research. To evaluate the accuracy of self-reported sexual behavior, we evaluated self-reported abstinence following participation in an STD/HIV prevention trial and adolescents' acquisition of an incident STD, and identified predictors of unreliable reporting of sexual behavior.

Method: Data assessing sociodemographics, psychosocial mediators, and sexual behaviors were collected via self-administered interviews from 522 African American adolescent females prior to participating in a STD/HIV prevention trial. Additionally, adolescents provided self-collected vaginal swab to assess the prevalence of three STDs. STD-positive adolescents were treated and received counseling. At 6-month follow-up, adolescents completed a similar interview and provided vaginal swab specimen for STD assay. Contingency table analyses evaluated concordance between self-reported abstinence over the 6-month follow-up period and STD incidence. Bivariate analyses identified predictors of unreliable reporting.

Results: Of the 73 adolescents reporting abstinence from baseline to the 6-month follow-up assessment, 23.3% tested positive for a laboratory-confirmed STD. Adolescents who reported being abstinent, but testing positive for an STD at 6-month follow-up, had significantly higher condom barrier scores (p = .04) and lower scores on the condom interpersonal impact scale (p = .004).

Conclusion: Marked discordance was observed between adolescents' self-report of abstinence and their laboratory-confirmed STD incidence. Both barriers and attitudes towards condom use were predictors of unreliable reporting. These finding highlight the need to include biological markers (STDs or Y-chromosome PCR assay) to complement adolescents' self-reported sexual behavior and provide an objective and quantifiable marker for evaluating STD/HIV interventions.