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6 Methodological Issues in AIDS Surveys Surveys or, more generally, the method of asking questions and recording answers, continue to be one of the most important methods for obtaining essential information about the epidemiology of AIDS and HIV, the behaviors that spread HIV, and the effectiveness of AIDS prevention efforts. Previous chapters included numerous examples of surveys and observations about the methodological difficulties that often attend these measurements. Because of the central role surveys play in research on AIDS and HIV, this chapter focuses on methodological aspects of this data-gathering method that have important consequences for the usefulness of survey data. The technical material and methodological details in this chapter make it more difficult to read than preceding sections of the committee's report. The committee's aim in presenting this material is to provide researchers conducting AIDS surveys or analyzing data collected in such surveys with a detailed review of the current state of methodological research in this area. Readers who seek only a synopsis of the committee's conclusions and recommendations may wish to consult pages 27-34 of the summary chapter. Before turning to specifics, it may be useful to consider data gathering in general and the types of problems that may compromise the collection of accurate and informative data. One may usefully distinguish five aspects of survey data collection: (1) the Sedition of the population to be studied and the drawing of a target sample from that population; (2) the execution of the sample design, that is, finding the persons in the target sample and enlisting their cooperation in the survey; (3) the posing of questions to elicit the desired information; (4) the answering of those 359
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360 ~ AIDS: THE SECOND DECADE questions by the respondent; and (5) the recording of those answers (and subsequent data processing and analysis). To examine these elements, let us consider a hypothetical survey (much like the decennial census) that targeted all households in a par- ticular jurisdiction of the state of Texas. Let us suppose further that the information to be obtained concerned automobile ownership (e.g., how many automobiles were owned by each household, the make and year of the autos, etc.~. This survey, although not simple to conduct, would nev- ertheless be considerably less difficult to conduct than a survey seeking to assess behaviors that transmit HIV; in particular, · the survey involves matters of fact that are both open to direct observation and matters of public record (e.g., make and year of automobiles owned by household); · the topic is unlikely to be regarded as sensitive or"pn- vate" by respondents, although as in any survey some respondents may not wish to take the time to respond; · developing questions about this topic can draw on a widely shared vocabulary (i.e., there is little ambiguity about what constitutes a"car" or"ownership"~; · respondents who are not well informed can consult with other household members or check records (e.g., registration certificates); · checks of survey accuracy can be made at the group level (by comparing the rates of auto ownership found in the survey and in registration records) and at the individual level (by checking individual registrations; and · census data on income and statewide auto registration data are available to target the survey efficiently toward seg- ments of the population of particular interest (e.g., current or "potential" owners of Belchfire 500s). Surveys that inquire about sexual behaviors or IV drug use differ in several ways from the foregoing example, and these differences pro- vide a much greater challenge to the survey (or question-and-answer) method. First, many of the logical "target populations" for drug use and sexual behavior surveys cannot be identified reliably from official statistics. There are few reliable data on the distribution across the na- tion of persons who engage in behaviors that risk HIV transmission. 1 The survey may, however, produce detailed information that cannot be verified from public records- for example, the proportion of Belchfire SOOs owned by persons with 16+ years of education.
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AIDS SURVEYS ~ 361 Furthermore, the behaviors In question occur in private and cannot be verified by direct observation or public records. Many of the behaviors are actively concealed because they are considered illicit (IV drug use is illegal throughout the nation, and many sexual behaviors of interest in preventing HIV transmission are illegal in some states). Thus, the topics these surveys cover are likely to be highly sensitive, which may create difficulties in enlisting the cooperation of persons in a target sample and in obtaining permission from "gatekeepers" (e.g., high school authorities) who control access to particular populations (e.g., high school students). This chapter considers these problems and reviews the available em- pirical evidence gathered from surveys of sexual and drug use behaviors. Before beginning this review, however, some cautionary words are in or- der. The evidence presented here regarding errors in data about sensitive behaviors might lead some readers to unwarranted and wholesale rejec- tion of survey findings on these important topics.2 Indeed, considering the litany of difficulties presented In this chapter, some readers may ask whether anything at all can be learned from surveys or whether surveys have a useful role to play In research on AIDS and HIV transmission. The following considerations prompt the committee to answer "yes" to these questions. The most important consideration arises directly from the nature of the disease. HIV infection occurs through the joint operation of the biology of this particular infectious virus and the human behaviors that transmit it. In the absence of vaccines, aZZ interventions that seek to retard the spread of HIV infection focus on changing human behaviors to diminish the probability that the virus will be transmitted. Data on these behaviors are needed for a number of important purposes—for example, to understand the factors that motivate and shape the behaviors and to determine whether behaviors that transmit HIV are becoming less frequent ir1 the population. It might, of course, be argued that merely monitoring changes in the prevalence of HIV would be sufficient to determine whether behavioral change was occurring. Although this argument is true to some extent, there are important deficiencies in any strategy that eschews direct mea- surement of the behaviors themselves. Reliable data on HIV prevaler~ce and incidence, although of great value for many purposes, are only a final accounting of the number of infected and uninfected persons in the population. From the viewpoint of prevention, such statistics serve best as a catalog of failures. Yet, those who are uninfected are not necessarily 2The following pages borrow heavily from the discussion of errors in survey measurements in Turner and Martin (1984:Vol. 1, 1016) and Turner (1989).
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362 ~ AIDS: THE SECOND DECADE successes. For example, the very low rate of HIV infection in states like Wyoming does not necessarily imply that the population has adopted protective behaviors. Instead, the Tow rate of HIv prevalence could be attributable to an epidemiological happenstance (e.g., isolation in terms of sexual contacts and injection equipment sharing from populations with high HIV prevalence.) Determining whether protective behavioral changes have occulted (in Wyoming or anywhere else) requires asking questions about these risky behaviors. This activity, in turn, raises a host of methodological issues that are germane to survey research of all types plus some questions Hat are specific to surveys of drug use and sexual behavior. The questions may be quite basic: Are the respondents telling the truth? Do they understand the meaning of the survey questions in the same way the investigator does? Simple or complex, such questions inevitably introduce a degree of uncertainty into the interpretation of all survey data. Grappling with these issues forces an appreciation of the human interactions that produce survey measurements. Elsewhere it has been argued that fundamental aspects of the survey process are quintessentially social psychological in character. They arise from a complex interpersonal exchange, they embody the subjectivities of both interviewer and interviewee, and they present their interpreter with an analytical challenge that requires a multitude of assumptions concerning, among other things, how respondents experience the reality of the interview situation, decode the "meaning" of survey questions' and respond to the social presence of the interviewer arid the demand characteristics of the interview. (Turner, 1984:202) Although this "analytical challenge" may be substantial, researchers are aided in their task by several decades of methodological research (see, for example, Sudman and Bradburn t1974], Bradburn and SuUman [19791, Rossi, Wright, and Anderson t1983], Turner and Martin , and Catania et al. Lin press,a,b]~. A further reason for not abandoning behavioral measurement is that many of the problems encountered in this arena are not unique. Useful lessons may thus be learned from other disciplines that also confront such challenges. FALLIBILITY OF MEASUREMENT IN OTHER SCIENCES Fallibility and error are not confined to behavioral measurements, as evidenced by the decade-Ion" controversy surrounding the population
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AIDS SURVEYS ~ 363 statistics produced by the decennial censuses.3 Furthermore, just as falli- bility of measurement is not limited to behavioral measurements, neither is it limited to surveys or social statistics. For example, Hunter (1977) and Lide (1981) have noted the vanability among measurements of such elementary physical phenomena as the thermal conductivity of copper (Figure 6-11. As Hunter observed, "although each analyst measured a physical quality that did not vary with location or time, it is clear that a remarkable variability attended the measurements" (1977:21. He concluded: "The variation in attempting to evaluate the same physical constant is obvious. This example is not unusual. Similar plots of thermal conductivity as a function of temperature for approximately 400 common metals and matenals can be found in a supplement to the Journal (Ho, Powell, and Liley, 19741. Nor is the observed variation in the measure- ment of 'thermal conductivity' unique among physical parameters . . . (p. 21. Common biological measurements have shown similar fallibility. Examples include data collected by CDC that show substantial variation in the estimates made by different laboratones of the amount of lead in identical samples of blood. For a sample of blood with a putative lead concentration of 41 milligrams per deciliter (mg/DI), 100 cooperating laboratories produced measurements that ranged from 33 to 55 mg/DI; this result prompted the reviewer to observe: "Clearly, whatever the true amount of lead in a sample, the vanability demonstrated tin these measurements] guarantees numerous false alarms or perhaps more im- portant when the true level is high nonalanns" (Hunter, 1980:8701. Another category of fallibility in the physical sciences involves "dis- covenes" that are later shown to be expenmental artifacts. For example, between 1963 and 1974 more than SOO journal articles (including some in Science and Nature ~ discussed a supposed new substance: anomalous water, or polywater. Although it resembled ordinary water, polywater ,, allegedly had a~greater density, a reduced freezing point, and an elevated boiling point, among other anomalous properties. In the end, however, it was discovered that this "new substance'' was nothing more than an impure solution of ordinary water (Franks, 1981; Eisenberg, 1981~. Such examples indicate that the problems AIDS researchers confront when they seek to assess sexual arid drug-us~ng behavior are not unique in He urinals of scientific measurement. As Quinn McNemar observed more than 40 years ago, "Lalll measurement is befuddled win error. 3By October 1981, more than 50 lawsuits had been filed challenging the accuracy of the 1980 Cen- sus results and their use in legislative apportionment and fund allocation decisions (Citro and Cohen, 1985:9).
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364 1 o > By ~ ~ 14.1 C) Q Z Q O O as) Lo I ~ at, - C.) ,0 — CC ~ CC _ 3 ~ o o ~ Cat C ," 1 Lo ~ ~ , . ~ ~ ·- `r - ' ~ i. o 5~8;, [-by ~11~' ~ it, eN ~ ~ - 1- Tri\~ ~ : ~ . _ _ ! ,_N ,_~ M ·=lAllOnC~OO 1¢WH3H1 D - o 1c — 1- ~ ~ 1 ' £ , ~ C5 ~ _ C) o C) - to To ~ . ° C) _ ~ o C) , ~ ~ C! t5 1- ~ By &.- - ~ o ~ , ~ on . - ~ o C., ~ >` e~ ~ .— ~ , ._ ._ C) .' o ~ ces _ e~ CC ~ _ — — c: x o o F c, ~ , ~ ~i 8 ~ ~ 5 ~ O _ C~ ~ ~ O O :^ C ~ L~ ~ ~ ,, ~ _ ~ 3 ~o o o Z ~ :~^ 5:
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AIDS SURVEYS ~ 365 About this the scientist can and does do something; he ascertains the possible extent of the error, determines whether it is constant (biasing) or variable, or both, and ever strives to improve his instruments and techniques" (1946:294~. In the following pages the committee reviews what is currently known about the errors that afflict measures of sexual and drug-using behavior and offers some prescriptions for how future measurements might be improved. The first section of the chapter reviews the experience to date in mounting surveys and obtaining responses from the public. The second section considers the reliability and validity of responses obtained in surveys of sexual and drug use behaviors. The final section reviews the use of anthropological research strategies that may provide important complementary information to that obtained in surveys and that may also be crucial in questionnaire development to improve the accuracy and completeness of responses. RECRUITMENT OF RESPONDENTS IN SEX AND SEROPREVALENCE SURVEYS Much of what is now known about the epidemiology of AIDS has come from small-scale, local studies among subgroups thought to be at high risk for infection. Participants in these studies were recruited through various sources and means from the clientele of local clinics or treat- ment facilities or the membership rosters of local organizations, through newspaper advertisements and physician referrals, and occasionally from "street sampling." The yield from this research has been remarkably rich. From these studies, researchers have identified the principal mecha- nisms of HIV infection (i.e., transmission through sexual contact, sharing injection equipment in IV drug use, transfusion of contaminated blood products); verified sexual transmission of HIV from male to male, female to male, and male to female; measured the efficiency of transmission in specific kinds of sexual contacts; and discovered some of the basic fea- tures of the long natural history of this devastating disease. As valuable as these studies are, however, the data drawn from them cannot address many other important public health questions that arise because of AIDS, suck as: How large is the epidemic? What is the potential for general spread of HIV infection? Can an HIV epidemic be sustained through het- erosexual contact alone? To answer questions like these, the knowledge gained from measurements and observations caIried out in local studies of special subgroups must be applied in large-scale investigations of pop- ulations chosen not because of convenient or ready access but because of their importance in understanding the general course of the epidemic.
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366 ~ AIDS: THE SECOND DECADE This section considers the feasibility of sex and seroprevalence sur- veys as a means of measuring the distribution of sexual behaviors that risk HIV transmission and the distribution of HIV itself in general pop- ulations. Although such surveys may be designed in a variety of ways, all of the studies discussed here employ the same general procedures for participant selection: an unambiguous definition of the population to be studied and a form of sampling from this population that allows the probabilities of selection to be known. The potential advantages of a probability sampling program for selecting survey participants are well known. In principle, probability sampling permits the use of a large body of statistical theory to make inferences from the sample to the larger pop- ulation and avoids the possible biases inherent in recruitment by other means. The suggestion to use probability sampling for surveys of sexual behavior was made more than three decades ago in connection with a review of the statistical methods used in Kinsey, Pomeroy, and Mar- tin's Sexual Behavior in the Human Male (1948) (Cochran, Mosteller, and Tukey, 19531. The authors of this suggestion were a committee of the Commission on Statistical Standards of the American Statistical Association. At the invitation of Dr. Kinsey and the National Research Council's Committee for Research on Problems of Sex, they were asked to provide course! on ways to improve the statistical methods used in the Kinsey research. They recommended a step-by-step program of prob- ability sampling, beginning with a small pilot effort. They argued that research of this kind would provide a check on the results obtained with Kinsey's large, nonprobability sample. The committee was aware Hat problems of cost and potentially high rates of nonparticipation in such surveys would present special challenges. Their comments about the limits of this approach are worth quoting at length because the issues they raised more than 30 years ago in relation to Kinsey's work remain germane in evaluating the potential value of contemporary surveys of sexual behavior. In our opinion, no sex study of a broad human population can expect to present incidence data for reported behavior that are known to be correct to within a few percentage points. Even with the best available sampling techniques, there will be a certain percentage of the population who refuse to give histones. If the percentage of refusals is 10 percent or more, then however large the sample, there are no statistical principles which guarantee that the results are correct to within 2 or 3 percent, . . . but any claim that this is true must be based on the undocumented opinion that the behavior of those who refuse to be interviewed is not very different from that of those who are interviewed. These comments, which are not a criticism of [Kinsey, Pomeroy, and Martin's] research, emphasize the difficulty of answering the
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AIDS SURVEYS ~ 367 question: "How accurate are the results?", which is naturally of great interest to any user of the results of a sex study. (Cochran, Mosteller, and Tukey, 1953:675) The rationale for using response rates as a "yardstick" to assess the accuracy of survey estimates is twofold: (1) high response rates reduce the influence of selective participation in surveys and hence the potential for bias in the estimates, and (2) for a given target sample size and sample design, the higher the response rate, the larger the actual sample and the smaller the standard error of estimate. In other words, high response rates are better than low rates, provided the procedures used to achieve high response rates do not increase the degree of selectivity or inaccuracy of the responses. Few contemporary surveys on any topic achieve response rates higher than the 90 percent figure cited in Cochran, Mosteller, and Tukey's review of the Kinsey report; indeed, response rates in most surveys are considerably below that mark. In principle, then, questions about selective participation (i.e., about differences between respondents and nonrespondents) are of concern in judging the accuracy of most survey estimates, not only those that derive from surveys of sexual behavior. Such concerns have generated a substantial literature on the character of nonresponse in surveys and what to do about possibly biased estimation resulting from nonresponse (see, for example, Goyder's 1987 synthesis of nonresponse research and the series of volumes on incomplete data in sample surveys edited by Madow, Nisselson, and Olkin t19831~. Surveys with response rates that are much lower than 90 percent may still provide useful estimates of population characteristics if it can be established that participation or nonparticipation is unrelated to the characteristic for which an estimate is sought. Furthermore, response rates higher than 90 percent do not guarantee accurate estimation if survey participation is highly selective. Thus, in most cases, the value of the response rate by itself is insufficient justification for claims of accuracy or "representativeness" of survey estimates or for counterclaims that estimates fail in this respect. Such claims should be based on careful study, documentation, and possibly adjustment for bias as a result of refusals and other sources of nonresponse. In the following review, the committee examines recent efforts to survey sexual behavior and related HIV risk factors that use probability samples from general populations. The review focuses on participation in such surveys and is motivated by the same concerns about nonresponse in probability samples that were expressed in the review of the Kinsey report. It attempts to answer three main questions: (1) What response
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368 ~ AIDS: THE SECOND DECADE rates have been achieved in recent surveys of sexual behavior? (2) What survey designs and procedures appear to be associated with higher versus lower levels of participation? and (3) What can be said, at present, about differences between sample persons who participate in sex surveys and sample persons who refuse to participate or do not participate for other reasons? (There is as yet too little information to hazard general statements about differences between participants and nonparticipants in seroprevalence surveys.) Questions about the validity and reliability of survey responses about sexual behavior, which were also noted in reviews of the Kinsey report, will be discussed in the later sections in this chapter. Scope of the Review The committee chose 15 surveys for its review, including some that are national in scope and some that target local populations. Most of these studies were initiated after the AIDS epidemic began in response to the need for population-based estimates of sexual behaviors known to be associated with HIV transmission. Both telephone and face-to-face interviewing methods are represented, along with data collection through self-administered questionnaires. There are wide variations among the surveys in the proportion of questions they devote to measuring sexual practices and other risk behaviors. Four surveys were included because of their potential importance for monitoring the prevalence of HIV Infection; these surveys attempted to collect a blood specimen for HIV serologic testing from each sample person. The committee used four criteria for including studies In its review: (1 ) there was at least a minimal attempt to collect data on personal sexual behavior and, in some cases, other HIV risk factors as well; (2) some form of probability sampling was employed; (3) a response rate of the form (number of survey participants)/(number of sample persons) could be calculated; and (4) enough documentation was available to identify the principal characteristics of the survey design and sampling procedures. Information about the designs, sampling procedures, and participation rates of these surveys appears in Table 6-~. For the most part, the committee collected information about these surveys from published accounts in books, journal articles, and survey field reports. (The source documents are cited in Table 6-1.) OccasioIl- ally, it was necessary to rely on conversations with survey field managers, especially for surveys that had been completed at the time of this writing. In several other cases, documentation is partial because of incomplete reporting or recor~keeping, or both. For these reasons, and because the total number of surveys is small, the committee has not attempted a
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AIDS SURVEYS ~ 369 statistical analysis of participation rates in relation to survey characteris- tics. Nevertheless, the review does identify differences in response rates in sex surveys that appear to be associated with procedural and design vanations. It also reveals several opportunities for learning more about patterns of participation and nonparticipation. Participation in Sex Surveys Data Collection Procedures and Response Rates Each of the surveys listed in Table 6-1 asked respondents to report on certain aspects of their past and present sexual behavior. For the most part, the questions used in recent surveys (i.e., those initiated after the AIDS epidemic began) attempt to measure the occurrence of sexual behaviors associated with HTV infection and transmission and fall into three general categones: sexual orientation (with a focus on homosexuality), selection of sexual partners (number and characteristics of partners, presence of same-sex partnerships), and manner of sexual intercourse (e.g., anal, vaginal, oral). Because of the sensitive and highly personal nature of these questions, virtually all of the surveys made some provision to permit respondents to reveal the details of their sexual behavior without undue embarrassment or fear of disclosure to third parties. Most of the surveys included one or more of the following: special guarantees mat responses would be kept confidential; assurance of anonymity that is, that the person viewing the results would not know the identity of the respondent; privacy during the interview; and placement of the sensitive questions near the end of the interview. Apart from these similanties, the 15 surveys differ widely with respect to basic methods of data collection and number of questions about sexual behavior. Interviewing was conducted by telephone in four of the surveys (nos. 3, 4, 9, and 10 in Table 6-1), by face-to-face interview in five cases (nos. 7, 8, 12, 13, and 14), and by a combination of face- to-face interview and self-administered questionnaire (SAQ) in six (nos. I, 2, 5, 6, Il. and 151. Virtually all of the surveys that contained Tong, detailed inventories of sexual questions were conducted through face-to- face or telephone interviews. When SAQs were used, the length of the self-administered forms varied considerably (some did not exceed ~ or 2 pages whereas others [e.g., survey no. 1] were more than 10 pages long). The most frequently used data collection procedure was a face-to- face interview followed by a relatively brief SAQ that focused on sexual behavior. In all instances, after the respondent completed the SAQ, it was placed in an envelope (stripped of identifying information except
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462 ~ AIDS: THE SECOND DECADE Klassen, A. D., Williams, C. J., Levitt, E. E., Miniot-Rudkin L., Miller H., and Gunjal, S. (1989) Trends ire premarital sexual behavior. In C. F. Turner, H. G. Miller, and L. E. Moses, eds., AIDS, Sexual Behavior, and Intravenous Drug Use. Washington, D.C.: National Academy Press. Koblin, B., McCusker, J., Lewis, B., Sullivan, J., Birch, F., and Hagen, H. (1988) Racial differences in HIV infection in IVDUs. Presented at the Fourth International Conference on AIDS, Stockholm, June 12-16. Koester, S. (1989a) The risk of HIV transmission from sharing water, drug-mixing con- tainers and cotton filters among intravenous drug users. Unpublished manuscript. University of Colorado School of Medicine, Boulder, Colo. Koester, S. (1989b) When push comes to shove: Poverty, law enforcement and high risk behavior. Unpublished manuscript. University of Colorado School of Medicine, Boulder, Colo. Koss, M. P., and Gidycz, C. A. (1985) Sexual experiences survey: Reliability and validity. Journal of Consulting and Clinical Psychology 53:422~23. Lange, W. R., Snyder, F. R., Lozovsky, E., Kaistha, V., Jaffe, J. H., et al. (1988' Geographic distribution of human immunodeficiency virus markers in parenteral drug abusers. American Journal of Public Health 78:443 4216. Leach, C., Viker, S., Kuhls, T., Patois, N., Cherry, J., and Christenson, P. (1989) Changes in sexual behavior of a cohort of female health care workers dunag the AIDS era. Presented at the Fifth International Conference on AIDS, Montreal, June =9. Leonard, T. L. (1990) Male clients of female street prostitutes: Unseen partners in sexual disease transmission. Medical Anthropology Quarterly 4:41-55. Lessler, J., Tourangeau, R., and Salter, W. (1989) Questionnaire design in the cognitive research laboratory. Vital and Health Statistics Senes 6, Whole No. 1. Lever, J., Rogers, W. H., Carson, S., Hertz, R., and Kanouse, D. E. (1989) Behavioral patterns of bisexual males in the U.S., 1982. Presented at the Fifth International Conference on AIDS, Montreal, June =9. Levinger, G. (1966) Systematic distortion in spouses' reports of preferred and actual sexual behavior. Sociometry 29:291-299. Lide, D. R., Jr. (1981) Cntical data for critical needs. Science 212:1343-1349. Loftus, E. F. (1975) Leading questions and the eyewitness report. Cognitive Psychology 7:56~572. Loftus, E. F., and Marburger, W. (1983) Since the eruption of Mt. St. Helens, has anyone beaten you up? Improving the accuracy of retrospective reports with landmark events. Memory and Cognition 11: 11~120. Loftus, E. F., and Palmer, J. C. (1974) Reconstruction of automobile destruction: An example of the interaction between language and memory. Journal of Verbal Learning and Verbal Behavior 13:585-589. LoPiccolo, J., and Steger, J. C. (1974) The sexual interaction inventory: A new instrument for assessment of sexual dysfunction. Archives of Sexual Behavior 3:585-595. Luetgert, M. J., and Armstrong, A. H. (1973) Methodological issues in drug usage sur- veys: Anonymity, recency, and frequency. International Journal of the Addictions 8:683~89.
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AIDS SURVEYS ~ 463 MacKuen, M. B. (1981) Social communication and the mass policy agenda. In M. B. MacKuen and S. L. Coombs, eds., More than News: Media Power in Public Affairs. Beverly Hills, Calif.: Sage. MacKuen, M. B. (1984) Reality, the press, and citizens' political agendas. In C. F. Turner and E. Martin, eds., Surveying Subjective Phenomena. Vol. 2. New York: Russell Sage. MacKuen, M. B. and Turner, C. F. (1984) The popularity of presidents: 1963-80. In C. F. Turner and E. Martin, eds., Surveying Subjective Phenomena. Vol. 2. New York: Russell Sage.. Maddux, J., and Desmond, D. (1975) Reliability and validity of inflation from chronic heroin users. Journal of Psychiatric Research 12:87-95. Madow, W. G., Nisselson, H., and Olkin, I., eds. (1983) Incomplete Data in Sample Surveys. Vol. 1, Report and Case Studies; Vol. 2, Theory and Bibliographies; Vol. 3, Proceedings of the Symposium. New York: Academic Press. Magura, S., Goldsmith, D., Casnel, C., Goldstein, P. J., and Lipton, D. S. (1987) The validity of methadone clients' self-reported drug use. International Journal of the Addictions 22:727-749. Maisto, S. A., and O'Farrell, T. J. (1985) Comment on the validity of Watson et al.'s "Do alcoholics give valid self-reports?" Journal of Studies on Alcohol 46:447~53. Maisto, S. A., Sobell, L. C., and Sobell, M. B. (1982-83) Corroboration of drug abusers' self-reports through the use of multiple data sources. American Journal of Drug and Alcohol Abuse 9:301-308. Marasca, G., D'Arcangelo, E., De Candido, D., Della Giusta, G., Liseo, B., et al. (1989) Sexual behaviour and HIV related knowledge among a random sample of young population of Italy. Presented at the Fifth International Conference on AIDS, Montreal, June =9. Marks, I. M., and Sartonus, N. H. (1968) A contribution to the measurement of sexual attitude. Journal of Nervous and Mental Disease 145:441051. Marshall, P., O'Keefe, J. P., Fisher, S. G., Caruso, A. J., and Surdukowski, J. (In press) Patients' fear of contracting AIDS from physicians. Medical Anthropology Quarterly. Martin, J. L., and Vance, C. S. (1984) Behavioral and psychosocial factors in AIDS: Methodological and substantive issues. American Psychologist 39:1303-1308. Mason, T. (1988) AIDS prevention among black IV drug users and their sexual partners in a Baltimore public housing project. Presented at the First International Symposium on Information and Education on AIDS, Ixtapa, Mexico, October 18. Mason, T. (1989) The politics of culture: Drug users, professionals, and the meaning of needle sharing. Presented at the Annual Meeting of the Society for Applied Anthropology, Santa Pe, April. Mason, T. (In press) A preliminary look at social and economic dynamics influencing drug markets, drug use pattems, and HIV risk behaviors among injecting drug users in two Baltimore networks. In Proceedings of the Community Epidemiology Work Group: Chicago, Illinois, June 1989. National Institute on Drug Abuse, Division of Epidemiology and Statistical Analysis, Rockville, Md. May, R. M., and Anderson, R. M. (1987) Transmission dynamics of HIV infection. Nature 326:137-142. May, R. M., Anderson, R. M., and Blower, S. M. (1989) The epidemiology and transmission dynamics of HIV-AIDS. Daedalus 118:163-201.
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Representative terms from entire chapter: