AIDS and Behavior

, Volume 22, Issue 7, pp 2368–2379 | Cite as

Beyond Social Desirability Bias: Investigating Inconsistencies in Self-Reported HIV Testing and Treatment Behaviors Among HIV-Positive Adults in North West Province, South Africa

  • Alyssa C. MooneyEmail author
  • Chadwick K. Campbell
  • Mary-Jane Ratlhagana
  • Jessica S. Grignon
  • Sipho Mazibuko
  • Emily Agnew
  • Hailey Gilmore
  • Scott Barnhart
  • Adrian Puren
  • Starley B. Shade
  • Teri Liegler
  • Sheri A. Lippman
Original Paper


This mixed-methods study used qualitative interviews to explore discrepancies between self-reported HIV care and treatment-related behaviors and the presence of antiretroviral medications (ARVs) in a population-based survey in South Africa. ARV analytes were identified among 18% of those reporting HIV-negative status and 18% of those reporting not being on ART. Among participants reporting diagnosis over a year prior, 19% reported multiple HIV tests in the past year. Qualitative results indicated that participant misunderstandings about their care and treatment played a substantial role in reporting inaccuracies. Participants conflated the term HIV test with CD4 and viral load testing, and confusion with terminology was compounded by recall difficulties. Data entry errors likely also played a role. Frequent discrepancies between biomarkers and self-reported data were more likely due to poor understanding of care and treatment and biomedical terminology than intentional misreporting. Results indicate a need for improving patient-provider communication, in addition to incorporating objective measures of treatment and care behaviors such as ARV analytes, to reduce inaccuracies.


HIV Antiretroviral treatment Adherence South Africa Measurement error Bias 



We thank the team at I-TECH South Africa, including all field workers, community health workers, and site supervisors who conducted the survey. We thank the North West Provincial Department of Health, Dr. Ruth Segomotsi Mompati District DoH, Lekwa Teemane and Greater Taung Sub-district DoH, and the Provincial Research Committee for their support. We thank the participants for their generosity and willingness to be part of this study.


This project was funded by the US Centers for Disease Control and Prevention Cooperative Agreement 5U2GGH000324-02. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the views of CDC.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Committee for Human Research at the University of California, San Francisco; the Human Subjects Division at University of Washington; the Human Sciences Research Council Research Ethics Committee in South Africa; the Policy, Planning, Research, Monitoring and Evaluation Committee for the North West Provincial Department of Health; and the CDC’s Center for Global Health, Human Research Protection Office, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Alyssa C. Mooney
    • 1
    • 8
    Email author
  • Chadwick K. Campbell
    • 2
  • Mary-Jane Ratlhagana
    • 3
  • Jessica S. Grignon
    • 3
    • 4
  • Sipho Mazibuko
    • 3
  • Emily Agnew
    • 2
  • Hailey Gilmore
    • 2
  • Scott Barnhart
    • 3
    • 4
  • Adrian Puren
    • 5
    • 6
  • Starley B. Shade
    • 1
    • 2
  • Teri Liegler
    • 7
  • Sheri A. Lippman
    • 2
  1. 1.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  2. 2.Center for AIDS Prevention Studies, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  3. 3.International Training and Education Center for Health (I-TECH) South AfricaPretoriaRepublic of South Africa
  4. 4.Department of Global HealthUniversity of WashingtonSeattleUSA
  5. 5.National Institute for Communicable Diseases/NHLSJohannesburgRepublic of South Africa
  6. 6.Division of Virology, School of PathologyUniversity of the WitwatersrandJohannesburgRepublic of South Africa
  7. 7.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  8. 8.Department of Epidemiology & BiostatisticsUniversity of California San FranciscoSan FranciscoUSA

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