Evaluating AIDS prevention interventions using behavioral and biological outcome measures.
OBJECTIVE
To begin a dialogue on the role of behavioral and biological outcome measures in evaluating the effectiveness of behavior change interventions to reduce the risk of transmitting and acquiring HIV and other sexually transmitted diseases (STDs).


METHODS
A selective review of the literature was undertaken to identify issues and problems associated with the use of behavioral and biological outcome measures. In particular, the article considers the validity of self-reports and the theoretical relationships between behavioral and biological measures.


RESULTS
Available data suggest that when proper care is taken, behavioral self-reports are valid. Similarly, sensitive and specific diagnostic tests are available, particularly for bacterial STDs. However, even when diagnostic tests and behavioral self-reports provide valid data, one should not expect a simple relationship between behavioral and biological measures.


CONCLUSIONS
Both behavioral and biological measures are important outcomes for studying the efficacy and effectiveness of behavior-change interventions. However, one measure cannot substitute for or validate the other, and neither serves as a true surrogate for HIV prevalence or incidence. Therefore, it is important to better understand the relationship among STDs, HIV, and self-reported condom use. To do this, it will first be necessary to assess correct as well as consistent condom use.
Fishbein
M
M
Annenberg Public Policy Center, Annenberg School for Communication, University of Pennsylvania, Philadelphia 19104, USA.
Pequegnat
W
W
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D017280:Condoms / Q000706:statistics & numerical data; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission