---
title: "List randomization to estimate sensitive sexual behaviors among women with HIV in Lilongwe, Malawi"
id: "pubmed-42063267"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42063267"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42063267/"
doi: "10.1093/aje/kwag091"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# List randomization to estimate sensitive sexual behaviors among women with HIV in Lilongwe, Malawi
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42063267
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42063267/)
- **DOI:** [10.1093/aje/kwag091](https://doi.org/10.1093%2Faje%2Fkwag091)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study evaluated **list randomization** as a technique to reduce social desirability bias in self-reported sexual-behavior data among women of reproductive age living with **HIV** in Lilongwe, Malawi. - Data came from the Family Planning and Antiretroviral Therapy (FP-ART) cohort; participants were randomized to two response modes: direct response or list response for five blocks of true/false statements. - Each block contained three nonsensitive statements plus one sensitive statement addressing either **condom use** or **HIV disclosure**; participants reported the number of true statements rather than answering each item when using the list format. - For each sensitive item the authors calculated the **prevalence difference** (PD) comparing list response visits to direct response visits, overall and stratified by socioeconomic status (as proxied by roof type). - For four of the sensitive statements, the PDs were negligible, indicating little change in estimated prevalence between list and direct responses. - One exception: report of always using a condom was higher at list response visits (53.1%) versus direct response visits (34.7%); PD 18.5% (95% CI, 6.2%–30.7%), indicating a substantial and statistically imprecise increase with list randomization. - The elevated estimate for always using a condom with list response was attenuated among participants with higher socioeconomic status. - Overall, list randomization did not meaningfully change prevalence estimates for most sexual-health items in this sample; the single unexpected positive-behavior result suggests context-specific effects. - The authors conclude that evaluating list randomization in other settings and populations is warranted to determine generalizability and utility for measuring sensitive behaviors. - Keywords reported: HIV/AIDS; list randomization; measurement error; sexual health; women’s health.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42063267/#linkout) Title & authors Abstract Conflict of interest statement Figures References Publication types MeSH terms Grants and funding LinkOut - more resources Randomized Controlled Trial Am J Epidemiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Epidemiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Epidemiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42063267/) . 2026 Sep 3;195(9):2408-2415. doi: 10.1093/aje/kwag091. # List randomization for prevalence estimation of sensitive behavioral data among women with HIV of reproductive age in Lilongwe, Malawi [Karen Diepstra](https://pubmed.ncbi.nlm.nih.gov/?term=Diepstra+K&cauthor_id=42063267)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-1 "Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [Daniel Westreich](https://pubmed.ncbi.nlm.nih.gov/?term=Westreich+D&cauthor_id=42063267)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-1 "Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [Paul N Zivich](https://pubmed.ncbi.nlm.nih.gov/?term=Zivich+PN&cauthor_id=42063267)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-1 "Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [John Chapola](https://pubmed.ncbi.nlm.nih.gov/?term=Chapola+J&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-3 "Department AU: of Health Policy Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [Clara Lemani](https://pubmed.ncbi.nlm.nih.gov/?term=Lemani+C&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi."), [Agatha Bula](https://pubmed.ncbi.nlm.nih.gov/?term=Bula+A&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi."), [Chalimba Lusewa](https://pubmed.ncbi.nlm.nih.gov/?term=Lusewa+C&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi."), [Jennifer H Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+JH&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#full-view-affiliation-4 "School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.") Affiliations Expand ### Affiliations * 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. * 2 School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi. * 3 Department AU: of Health Policy Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. * 4 School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. * PMID: **42063267** * PMCID: [ PMC13160244 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13160244/) * DOI: [ 10.1093/aje/kwag091 ](https://doi.org/10.1093/aje/kwag091) Item in Clipboard Randomized Controlled Trial # List randomization for prevalence estimation of sensitive behavioral data among women with HIV of reproductive age in Lilongwe, Malawi Karen Diepstra et al. Am J Epidemiol. 2026. Show details Display options Display options Format Abstract PubMed PMID Am J Epidemiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Epidemiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Epidemiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42063267/) . 2026 Sep 3;195(9):2408-2415. doi: 10.1093/aje/kwag091. ### Authors [Karen Diepstra](https://pubmed.ncbi.nlm.nih.gov/?term=Diepstra+K&cauthor_id=42063267)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-1 "Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [Daniel Westreich](https://pubmed.ncbi.nlm.nih.gov/?term=Westreich+D&cauthor_id=42063267)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-1 "Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [Paul N Zivich](https://pubmed.ncbi.nlm.nih.gov/?term=Zivich+PN&cauthor_id=42063267)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-1 "Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [John Chapola](https://pubmed.ncbi.nlm.nih.gov/?term=Chapola+J&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-3 "Department AU: of Health Policy Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States."), [Clara Lemani](https://pubmed.ncbi.nlm.nih.gov/?term=Lemani+C&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi."), [Agatha Bula](https://pubmed.ncbi.nlm.nih.gov/?term=Bula+A&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi."), [Chalimba Lusewa](https://pubmed.ncbi.nlm.nih.gov/?term=Lusewa+C&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi."), [Jennifer H Tang](https://pubmed.ncbi.nlm.nih.gov/?term=Tang+JH&cauthor_id=42063267)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-2 "School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42063267/#short-view-affiliation-4 "School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.") ### Affiliations * 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. * 2 School of Medicine, University of North Carolina at Chapel Hill, UNC Project-Malawi, Lilongwe, Malawi. * 3 Department AU: of Health Policy Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. * 4 School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. * PMID: **42063267** * PMCID: [ PMC13160244 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13160244/) * DOI: [ 10.1093/aje/kwag091 ](https://doi.org/10.1093/aje/kwag091) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract Self-reported data are subject to reporting biases, including social desirability bias. List randomization is one method that can help mitigate the impact of such biases. Here, we examined the utility of list randomization among women of reproductive age living with HIV in sub-Saharan Africa. In the Family Planning and Antiretroviral Therapy study, participants were randomized to answer 5 blocks of true/false statements via either direct or list response. Each block contained 3 nonsensitive statements and 1 sensitive statement related to either condom use or HIV disclosure. For each sensitive statement, we calculated the prevalence difference (PD) comparing list response to direct response overall and stratified by socioeconomic status. The PD for 4 of the sensitive statements was negligible. However, we found that self-report of always using a condom was reported by 53.1% at list response visits vs 34.7% at direct response visits (PD, 18.5%; 95% CI, 6.2%-30.7%), a difference that was attenuated among those with higher socioeconomic status. In this setting, list randomization did not meaningfully change the estimated prevalence for most questions, except for one question, which unexpectedly produced a higher estimate for a positive behavior. Examining this method in other settings and populations is warranted. **Keywords:** HIV/AIDS; list randomization; measurement error; sexual health; women’s health. © The Author(s) 2026. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement This work was supported in part by R01-HD088279 (JHT), T32 AI070114 (KD), and K01AI177102 (PNZ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The study sponsor had no input into the design, analysis, or decision to submit for publication. The authors report no conflicts of interest. ## Figures [ ![Figure 1.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b6a/13160244/aba06e8c71e4/nihms-2171056-f0001.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b6a/13160244/ef77c008dcb2/nihms-2171056-f0001.jpg) ** Figure 1. ** Prevalence of sexual health-related behaviors… ** Figure 1. ** Prevalence of sexual health-related behaviors among list response versus direct response visits using… **Figure 1.** Prevalence of sexual health-related behaviors among list response versus direct response visits using data from the Family Planning and Antiretroviral Therapy (FP-ART) cohort study Abbreviations: PD: prevalence difference [ ![Figure 2.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b6a/13160244/e748ccebc45b/nihms-2171056-f0002.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b6a/13160244/78cecadfe015/nihms-2171056-f0002.jpg) ** Figure 2. ** Prevalence of sexual health-related behaviors… ** Figure 2. ** Prevalence of sexual health-related behaviors among list response versus direct response visits stratified… **Figure 2.** Prevalence of sexual health-related behaviors among list response versus direct response visits stratified by roof type (socioeconomic status) Panel A. Responses for rudimentary roof/low socioeconomic status (n=548 visits) Panel B. Responses for metal roof/high socioeconomic status (n=1,898 visits) Abbreviations: PD: prevalence difference [ ![Figure 2.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b6a/13160244/e748ccebc45b/nihms-2171056-f0002.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b6a/13160244/ee4cbd868cea/nihms-2171056-f0003.jpg) ** Figure 2. ** Prevalence of sexual health-related behaviors… ** Figure 2. ** Prevalence of sexual health-related behaviors among list response versus direct response visits stratified… **Figure 2.** Prevalence of sexual health-related behaviors among list response versus direct response visits stratified by roof type (socioeconomic status) Panel A. Responses for rudimentary roof/low socioeconomic status (n=548 visits) Panel B. Responses for metal roof/high socioeconomic status (n=1,898 visits) Abbreviations: PD: prevalence difference [See this image and copyright information in PMC](https://pubmed.ncbi.nlm.nih.gov/42063267/) ## References 1. 1. Lash TL, VanderWeele TJ, Haneause S, Rothman K. Modern Epidemiology. Wolters Kluwer Health; 2021. Accessed April 11, 2023. 2. 1. Latkin CA, Edwards C, Davey-Rothwell MA, Tobin KE. The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addict Behav. 2017;73:133–136. doi: 10.1016/j.addbeh.2017.05.005 - [DOI](https://doi.org/10.1016/j.addbeh.2017.05.005) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC5519338/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/28511097/) 3. 1. Greenland S The effect of misclassification in the presence of covariates. Am J Epidemiol. 1980;112(4):564–569. doi: 10.1093/oxfordjournals.aje.a113025 - [DOI](https://doi.org/10.1093/oxfordjournals.aje.a113025) - [PubMed](https://pubmed.ncbi.nlm.nih.go
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