World Journal of AIDS, 2013, 3, 345-349
Published Online December 2013 (
Open Access WJA
The Influence of Social Desirability on Self-Reported
Sexual Behavior in HIV Survey in Rural Ethiopia
Alexander Vu1,2*, Kiemanh Pham1,2, Nhan Tran2, Saifuddin Ahmed3
1Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, USA; 2Department of International Health,
The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; 3Department of Population, Family and Reproductive
Health and Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Email: *
Received September 4th, 2013; revised October 4th, 2013; accepted October 11th, 2013
Copyright © 2013 Alexander Vu et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective: It is in order to examine associations between social desirability (SD) and self-reports of abstinence among
youths in rural Ethiopia. Methods: Youths of ag es 15 - 24 (114 participants) were administered qu estionnaire to assess
HIV knowledge and primary abstinence and a modified Marlowe-Crowne Social Desirability Scale to assess SD bias.
The relationships between SD groups (dichotomized into high and low) and abstinence by various characteristics were
assessed by using Fisher’s exact p-values. Results: The odds of individuals reporting abstinence were 13.2 times
greater in the high SD group compared to the low SD group (p-value 0.002) when adjusted for education, gender, age
group, and HIV know ledge. The differences in abstinence b etween the high and low SD score groups were also exam-
ined for selected variables. Conclusions: Individuals who exhibited more SD bias were more likely to report primary
abstinence. SD bias should be considered when conducting self-reported surveys to measure the effectiveness of HIV
prevention progra ms.
Keywords: Social Desirability Bias; Self-Reported Sexual Behaviors; HIV Surveys
1. Introduction
HIV is a significant cause of mortality in sub-Saharan
Africa. In 2010, there were an estimated 22.9 million
infected people, making up 67% of HIV infections
worldwide [1]. In response to the alarming prevalence of
the infection, the President’s Emergency Plan for AIDS
Relief (PEPFAR) was established to combat the spread
of HIV. A significant portion of PEPFAR’s efforts was
committed to prevent the spread of HIV through the
promotion of ABC programs (abstinence, being faithful,
condom use). This effort is associated with decreasing
the burden of HIV in sub-Saharan Africa where many of
PEPFAR’s priority countries are located. In Uganda and
Zimbabwe, there was an increase in abstinence and a
decrease in HIV prevalence [2,3]. Self-reported surveys
to measure the sexual behaviors of the beneficiaries of
abstinence promotion programs are commonly used to
assess the effectiveness of these programs. However,
self-reported surveys are prone to the effect of social
desirability (SD).
SD is the tendency of respondents to reply in a manner
which would be viewed positively by their peers or
which is consistent with social norms and expectations.
SD bias is a particular concern in studies, which meas-
ures HIV knowledge, attitudes, and practices (KAP) be-
cause of the sensitivity of the subject matter [4]. Ques-
tionnaires of sexual behavior have been shown to be
susceptible to misreport and underreporting [5 ]. In Africa
in particular, und erreporting of sexual activities has been
found in reports of sexual behavior in Tanzania and of
HIV KAP in rural Uganda [6,7]. Furthermore, it has been
shown that demographic factors may be associated with
differences in SD. In one study of Malawian teenagers
examining different methods of interviews, males re-
sponded to questions about sexual behavior differently
depending on the interview method while females did not
differ in their response [8]. In another study examining
reports of non-marital partnerships, there was a different
rate in response depending on age [9]. While these stud-
ies show that demographic characteristics may be associ-
ated with different responses, studies have also shown
*Corresponding a uthor.
The Influence of Social Desirability on Self-Reported Sexual Behavior in HIV Survey in Rural Ethiopia
that there may be differences in SD among different eth-
nic groups. One study, for example, demonstrated a dif-
ference in measures of SD between Latinos and non-
Latino Caucasians in the United States [10].
To address the issue of misreport in self-reported
questionnaires, the Marlow-Crowne Social Desirability
Scale (MC-SDS) was developed in 1960 to measure the
effect of social desirability [11]. The scale has been vali-
dated in the United States, where it was originally de-
veloped [12-14]. Subsequently, it has been tested in other
high-income countries [15] as well as in low- and mid-
dle-income (LMIC) countries [16]. No such studies have
been conducted in sub-Saharan Africa. We have tested
the MC-SDS and reported on the reliability of the MC-
SDS in four African countries [17].
The objective of this study is to examine the associa-
tion between SD bias and the self-reported levels of pri-
mary abstinence among unmarried youths, age 15 - 24, in
rural Ethiopia. To the best of our knowledge, there is no
literature to date which focused on the relationship be-
tween SD bias and self-reports of sexual abstinence. We
hypothesize that individuals who scored high on MC-S DS
were more likely to over-report primary abstinence.
2. Methods
2.1. Formative Research
During the formative phase of the study, which took
place during July 2008, the team consulted with commu-
nity leaders working in HIV preventio n programs, NGOs,
and other stakeholders in Ethiopia to assess the feasibil-
ity of the study and plan for its implementation; this in-
cluded pilot-testing of the tool, identifying locations for
the study, and defining potential populations for recruit-
A comprehensive review of the literature was then
undertaken to determine the state of knowledge on sur-
vey research on HIV in Africa and the effect of SD bias
on self-reported surveys. The literature review identified
various scales that had been developed to quantify the
effects of social desirability bias on self-rep orted surveys
including the scale developed by Edwards [18], the Lie
scale from the Eysenck Personality Inventory [19], and
the Marlowe Crowne scale. The MC-SDS was chosen
because it has been more widely cited in the literature
and had been applied in other LMIC settings.
The Marlow Crowne Social Desirability Scale was
translated into Amharic by local translators and then
back-translated to confirm the language was correct.
Under the guidance of researchers from Johns Hopkins,
local research assistants pilot-tested the translated ques-
tionnaire with a convenience sample to assess the study
population’s understanding of the translated MC-SDS.
Additional edits were made through an iterative process
to ensure that the trans lations captured the intended me an -
ing of the statements.
As the questions were initially designed for use in
high-income countries, some statements referenced cul-
tural practices that were not applicable to LMIC. Of the
MC-SDS’s original 33 statements, five were omitted
after the pilot-testing of the translated questionnaire be-
cause they referred to situations that wer e not appropriate
for the rural Ethiopian context. The process of modifying
the scale and the reliability of th e modified MC-SDS was
described in our previously published study [17].
2.2. Sample and Sampling Framework
This study was part of a larger evaluation of the Mobi-
lizing, Equipping, and Training Approach for Primary
Behavior Change in Youth (MET) Program implemented
by Samaritan’s Purse in rural Ethiopia. The goal of the
MET Project was to reduce the incidence of HIV infec-
tion through behavior modification, with an emphasis on
abstinence and fidelity using a grassroots, community
mobilization approach. To take advantage of the infra-
structure in place for assessing the program, data collec-
tion for this study was undertaken alongside the usual
monitoring and evaluation of the MET Project.
Lot quality assurance sampling (LQAS) served as the
sampling framework for this study as well as the evalua-
tion of the MET Project. A stratified, three-stage prob-
ability-sampling framework was used for recruitment.
The catchment area of the study in Ethiopia was divided
into six supervisory areas (SA’s); in each SA, 19 villages
were randomly selected based on a population propor-
tional-to-size method. In each of the 19 villages, a re-
spondent was randomly selected. Using LQAS, a total of
114 individuals were recruited from the entire catchment
After the period of pilot-testing and adjustment of the
modified MC-SDS, data collectors were trained in social
desirability bias, survey methods, and research ethics in
November 2008. The trained data collectors obtained
verbal consent in private settings; discussed how the col-
lected data were strictly protected; addressed any confi-
dentiality concerns of the participants; and administered
in-person the evaluation questionnaires and the modified
MC-SDS to each respondent. The Johns Hopkins School
of Medicine Institutional Review Board reviewed and
approved the study as conforming to the University’s
policies on ethical research.
2.3. Measures
Social desirability was measured using the modified
MC-SDS with 28 items. Each of the items asked the re-
spondent to answer with a “true” or “false”, with a “true”
answer scored as 1 and a “false” answer scored as 0.
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The Influence of Social Desirability on Self-Reported Sexual Behavior in HIV Survey in Rural Ethiopia 347
Thus, the maximum score for the modified MC-SDS was
28, representing the highest degree of social desirability
bias while 0 represented the least. The Cronbach’s α co-
efficient was used to estimate the reliability of the in-
strument for question items that assessed similar con-
structs [20]. We defined the threshold of acceptable in-
ternal consistency or reliability with an α coefficient of
0.70 or greater. The Cronbach’s α coefficient for the
modified MC-SDS for this study was 0.80.
HIV knowledge questions used in the study were in
accordance to the pre-validated questions and indicators
set by the United Nations General Assembly Special
Session on HIV/AIDS. Primary abstinence was defined
as never having had sex. The participants in this study
were men and women between the ages of 15 and 24
who had never been married.
2.4. Statistical Analyses
For the purpose of easy interpretation and ease of use
among field practitioners, we categorized the SD score
into two groups (low and high SD score) and then exam-
ined the relationship between abstinence and SD scores
by selected characteristics (gender, age group, education
level, and HIV knowledge). The determination of SD
score cut-off threshold was based on the midpoint sepa-
ration of the scale. Those who scored below 15 were
placed in the low group while those who scored 15 or
higher were placed in the high SD score group. Those
with no education or only a primary education were
grouped into the low education group while those with at
least a secondary education were in the high education
group. HIV knowledge was defined by correctly answer-
ing five questions about how HIV is transmitted. Those
who correctly answered all five questions were grouped
in the high HIV knowledge group while those who did
not answer one of the five questions correctly were
grouped into the low HIV knowledge group. The Fisher’s
exact p-value was used to assess differences between SD
score groups. Data was collected and entered into an
EpiInfo [21] database. The data were analyzed using
Stata/IC, version 11 [22].
3. Results
The research team recruited a total of 114 participants.
Table 1 shows th e background ch aracteristics of th e par-
ticipants. There was nearly an equal number of men
(48.2%) and women (51.8%). The majority of partici-
pants (80.7%) were between the ages of 15 - 19, and
fewer participants had only a primary education than a
secondary education (43.0% and 47.4%, respectively).
Participants were divided into high and low SD score
groups. The unadjusted odds of participants in the high
SD score group reporting abstinence was 5.21 times
greater than those in the low SD score group (p-value
0.002). This relationship was stronger with further ad-
justment for education, gender, age group, and HIV
knowledge (OR = 13.2; p-value 0.002).
Table 2 shows the relatio nship between SD and absti-
nence by selected characteristics. The high SD score
group had a higher proportion of abstinent respondents
than the low SD group regardless of the characteristic.
Among males, 86.1% of high SD score participants re-
ported abstinence compared to 58.3% of low SD score
participants (p-value 0.049). Females reported a signifi-
cant difference between the two groups with 91.7% of
high SD score individuals reporting abstinence versus
63.6% of low SD score individuals (p-value 0.033).
Almost all (97.3%) of the individuals in the 15 - 19
age group who had a high SD score reported abstinence
while 77.8% of individuals in the low SD score group
were abstinent (p-value 0.013). In the 20 - 24 age group,
Table 1. Background characteristics.
Total n = 114
Sex (%)
Male 55 (48.2)
Female 59 (51.8)
Age (%)
15 - 19 92 (80.7)
20 - 24 22 (19.3)
Education (%)
None 10 (8.8)
Primary 49 (43.0)
Secondary 54 (47.4)
Table 2. Percentage of self-reported abstinence between low
and high SDS score groups by selected variables.
Percentage of abstinence (n)
Low SD
Score < 15
High SD
Score 15
Fisher’s Exact
Male Gender 58.3 (7/12) 86.1 (37/43) 0.049
Female Gender 63.6 (7/11) 91.7 (44/48) 0.033
Age 15 - 19 77.8 (14/18) 97.3 (72/74) 0.013
Age 20 - 24 0.0 (0/5) 52.9 (9/17) 0.054
Education-Low 55.6 (5/9) 98.0 (49/50) 0.001
Education-High 64.3 (9/14) 78.1 (32/41) 0.313
HIV Knowledge-Low85.7 (6/7) 93.8 (30/32) 0.457
HIV Knowledge-High50.0 (8/16) 86.4 (51/59) 0.004
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The Influence of Social Desirability on Self-Reported Sexual Behavior in HIV Survey in Rural Ethiopia
more participants who had a high SD score reported ab-
stinence than in the low SD score group (52.9% and
0.0%, respectively). However, this difference was not
statistically significant (p-value 0.054), most likely due
to the small sample size of the 20 - 24 age group.
An overwhelming majority of those who had low
education and who were in the high SD group reported
abstinence (98.0%) while just over half of those in the
low education and low SD group reported abstinence
(55.6%). This difference was statistically significant (p-
value 0.001). A similar trend was observed in the high
education group (78.1% of the high SD group reported
abstinence compared with 64.3% of the low SD score
group), though this difference was not significant (p-
value 0.313).
Finally, the association between abstinence and SDS
scores was examined in relation to HIV knowledge. In
the low HIV knowledge group, those with high SD
scores were more likely to rep ort ab stinen ce th an tho se in
the low SD score group (93.8% and 85.7%, respectively),
though this difference was not statistically significant
(p-value 0.457). In the high HIV knowledge group,
86.4% of the high SD score participants reported absti-
nence compared with the low SD score group, in which
50.0% of participants reported abstinence. This differ-
ence was statistically significant (p-value 0.004).
4. Discussion
In the present study, we examined the relationship be-
tween social desirability and primary abstinence among
Ethiopian youths who participated in an HIV intervention
study. Our data showed a 13-fold difference in self-re-
ports of primary abstinence between individuals with a
high SD score compared to those with a low SD score.
The findings corroborated our original hypothesis that
individuals who scored high on the MC-SDS were more
likely to be influenced by social norms and to over-report
favorable behaviors. These individuals have a higher
tendency to want to be viewed positively among their
peers, and thus, would be more likely to give responses
regarding sexual behaviors that would conform to socie-
tal expectations.
Several factors were assessed to determine the influ-
ence on the relationship between social desirability and
self-reporting of abstinence. Our data indicated that gen-
der does not affect the relationship between SD and
self-reported abstinence. It is difficult to interpret if age
is a factor that affects SD. Both age groups showed a
trend that individuals in the high SD group were more
likely report abstinence. However, the relationship be-
tween SD and reported abstinence among the older age
group was not statistically significant. This was likely
due to the small sample size of the older sub-group. The
education level of the participant could be a factor that
affects SD. People with higher education showed no sig-
nificant difference in the reporting of abstinence. Those
with low education were more affected by SD, as noted
in the disparity in reports of abstin ence between the high
and low SD score groups. Surprisingly, the high HIV
knowledge group was more affected by SD in reports of
abstinence than the low HIV knowledge group. The high
HIV knowledge group had a statistically significant dif-
ference in reports of abstinence between the two SD
score groups, compar ed to the low HI V knowledg e group.
Perhaps with increased HIV knowledge, there is also
more awareness that certain sexual behaviors that may
increase the risk of contracting HIV are not condoned by
society. People with higher HIV knowledge may there-
fore have greater susceptibility to SD and are more likely
to report abstinence.
Whatever factors mediate the influence of social de-
sirability bias on reports of abstinence, the association
between SD and the self-reporting of sensitive subject
matters has potentially important implications for how
HIV research data in Ethiopia is in terpreted, especially in
research that looks at sexual behavior. From this study, it
appears that SD bias is high in Ethiopia. Thus, any data
collection that uses face-to-face interviews with ques-
tions that contain culturally sensitive subjects is poten-
tially susceptible to SD and misreporting. It is unclear
whether self-administered questionnaires or survey meth-
ods other than face-to-face interviews may reduce SD
This study had a few notable limitations. While the
tool has been validated, there may still have been prob-
lems with the MC-SDS. The instrument was initially
developed for use in the United States. As such, some
concepts may be tailored towards participants in high-
income countries. Key concepts in the some MC-SDS
statements may also have been lost during the translation.
In addition, participants may have been less comfortable
answering questions truthfully regarding sexual behavior
when they were interviewed face-to-face. The respon-
dents’ concerns of feeling judged by research staff or
lack of confidentiality may come into play. These con-
cerns may accentuate the SD effect. Finally, since the
study was conducted alongside the monitoring and eva-
luation of another program with budget constraints, the
sample size was sub-optimal to further the un derstanding
of how different demographic characteristics or factors
may affect the relationship between social desirability
and self-reports of sexual behaviors.
With these limitations, reproducing these results in
Ethiopia with a larger sample size, powered to detect sta-
tistical differences in the various factors that may affect
SD in sub-group analyses, would be a reasonable next
step in research on SD in Ethiopia in regards to HIV
prevention and sexual behaviors. Conducting a study to
understand the relationship between SD bias and self-
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The Influence of Social Desirability on Self-Reported Sexual Behavior in HIV Survey in Rural Ethiopia
Open Access WJA
reports of sexual behaviors in other African countries
would also be of value.
5. Conclusion
There is a relationship between high SD scores and
higher reports of primary abstinence. This suggests that
those who are more susceptible to social desirability bias
are more likely to report abstinence. This association has
potentially important implications for HIV programming
at large. Many HIV programs rely on self-reported sur-
veys to evaluate outcomes and impacts. If SD reflects the
possibility that respondents misrepresent socially unde-
sirable behavior, then the validity of self-reported survey
data comes into question, and the effectiveness of HIV
prevention programs may be over-estimated. It is impor-
tant for investigators conducting studies by using self-re-
ports of sensitive information to assess the potential of
social desirability bias to affect the results.
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