title: Lost in Translation: Language, Terminology, and Understanding of Penile-Anal Intercourse in an HIV Prevention Trial in South Africa, Uganda, and Zimbabwe.
abstract: Despite efforts to use culturally appropriate, understandable terms for sexual behavior in HIV prevention trials, the way in which participants interpret questions is underinvestigated and not well understood. We present findings from qualitative interviews with 88 women in South Africa, Uganda, and Zimbabwe who had previously participated in an HIV prevention trial. Findings suggested that participants may have misinterpreted questions pertaining to penile-anal intercourse (PAI) to refer to vaginal sex from behind and subsequently misreported the behavior. Three key issues emerge from these findings: first, the underreporting of socially stigmatized sexual behaviors due to social desirability bias; second, the inaccurate reporting of sexual behaviors due to miscomprehension of research terms; and third, the ambiguity in vernacular terms for sexual behavior and lack of acceptable terms for PAI in some languages. These findings highlight methodological challenges around developing clear and unambiguous definitions for sexual behaviors, with implications not only for clinical trials but also for clinical practice and sexual risk assessment. We discuss the challenges in collecting accurate and reliable data on heterosexual PAI in Africa and make recommendations for improved data collection on sensitive behaviors.
authors.affiliation: a School of Public Health and Family Medicine and Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine , University of Cape Town.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Duby
authors.affiliation: b RTI International , Women's Global Health Imperative.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: c University of Zimbabwe-University of California San Francisco Collaborative Research Programme.
authors.forename: Imelda
authors.initials: I
authors.lastname: Mahaka
authors.affiliation: c University of Zimbabwe-University of California San Francisco Collaborative Research Programme.
authors.forename: Otillia
authors.initials: O
authors.lastname: Munaiwa
authors.affiliation: d Makerere University-Johns Hopkins University Research Collaboration.
authors.forename: Josephine
authors.initials: J
authors.lastname: Nabukeera
authors.affiliation: e South African Medical Research Council.
authors.forename: Nozipho
authors.initials: N
authors.lastname: Vilakazi
authors.affiliation: e South African Medical Research Council.
authors.forename: Funeka
authors.initials: F
authors.lastname: Mthembu
authors.affiliation: f School of Public Health and Family Medicine , University of Cape Town.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Colvin
authors.affiliation: g Population Council.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mensch
authors.affiliation: h RTI International , Women's Global Health Imperative, and University of California , San Francisco.
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D036301:Qualitative Research; D012725:Sexual Behavior / Q000208:ethnology*; D013019:South Africa / Q000208:ethnology; D011795:Surveys and Questionnaires / Q000592:standards*; D009626:Terminology as Topic; D014175:Translating; D014454:Uganda / Q000208:ethnology; D015030:Zimbabwe / Q000208:ethnology