title: 'He said, she said': assessing dyadic agreement of reported sexual behaviour and decision-making among an HIV sero-discordant couples cohort in Uganda.
abstract: BACKGROUND
  The intimate nature of sexuality makes it challenging to accurately measure sexual behaviour. To assess response reliability, we examined agreement between couples in heterosexual HIV sero-discordant partnership on survey questions regarding condom use and sexual decision-making.
  
  
  METHODS
  Data for this analysis come from baseline data from a cohort study of HIV sero-discordant couples in Jinja, Uganda. We examined the degree of agreement between male and female partners on standard measures of sexual behaviour using the kappa (κ) statistic and 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Among 409 couples, the median age for the male partner was 41 [interquartile range (IQR) 35-48] years and the female partner was 35 (IQR 30-40) years. Among 58.2% of the couples, the male was the HIV-positive partner. Questions with high or substantial couple agreement included condom use at last sex (κ=0.635, 95% CI 0.551-0.718) and frequency of condom use (κ=0.625, 95% CI 0.551-0.698). Questions with low or fair couple agreement included decision-making regarding condom use (κ=0.385, 95% CI 0.319-0.451), wanting more biological children (κ=0.375, 95% CI 0.301-0.449) and deciding when to have sex (κ=0.236, 95% CI 0.167-0.306).
  
  
  CONCLUSIONS
  Survey questions assessing condom use had the highest level of couple agreement and questions regarding sexual decision-making and fertility desire had low couple agreement. Questions with high agreement have increased reliability and reduced measurement bias; however, questions with low agreement between couples identify important areas for further investigation, particularly perceived relationship control and gender differences.
authors.affiliation: Research Fellow, School of Population and Public Health, University of British Columbia, BC and BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Muldoon
authors.affiliation: Statistician, School of Population and Public Health, University of British Columbia, BC and BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Kanters
authors.affiliation: Research Manager, The AIDS Support Organisation, Kampala, Uganda.
authors.forename: Josephine
authors.initials: J
authors.lastname: Birungi
authors.affiliation: Senior Researcher, Global Health Sciences, University of California, San Francisco, CA USA.|Senior Researcher, Karolinska Institute, Stockholm, Sweden.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: King
authors.affiliation: Data Manager, The AIDS Support Organisation, Kampala, Uganda.
authors.forename: Maureen
authors.initials: M
authors.lastname: Nyonyintono
authors.affiliation: Centre Manager, The AIDS Support Organisation, Kampala, Uganda.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khanakwa
authors.affiliation: Associate Professor, Department of Medicine, University of British Columbia, BC and BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Moore
keywords: condom; decision-making; family planning service provision; human immunodeficiency virus; sexual behaviour; statistics