The Context of HIV Risk Among Drug Users and Their Sexual Partners

subgroup relevant measure, a topic discussed later in this chapter as
important in studying contextual effects.
Laumann and colleagues (1993) have applied a social network and
statistical strategy to investigate the undercount in HIV/AIDS prevalence
estimates. Their strategy is an application of multiplicity sampling, and it
is essentially useful as a proxy method for counting cases of a
phenomenon too rare to measure by using normal area probability
sampling procedures. This technique takes into account the respondent’s
probability of selection into the sample and the number and
characteristics of infected individuals identified in the network.
Demographic characteristics of network cases from the multiplicity
sample then are compared to those in official counts to estimate the
location(s) and rate(s) of undercounting. Such a method, combined with
what is known about geographic concentration of HIV/AIDS cases, might
provide important insights not only into changing rates and undercounts
but networks of infection diffusion as well. It is an example of how the
requirements for valid and reliable HIV/AIDS reports might lead to
improvisation of existing methods while preserving rigorous standards
for reliability and validity in measurement.
In that same article, Laumann and colleagues (1993) identified sources of
bias or error in AIDS case reporting and specifically cited those factors
they inferred as biasing against report of middle-class white infection at
the various reporting levels. They cite an estimated undercount of up to
30 percent in 1989 across the three levels of reporting that comprise the
Centers for Disease Control and Prevention’s (CDC’s) case counts
(Laumann et al. 1993).
Record bias of a different kind appeared in the author’s study and
concerned the failure to report AIDS infection on African-American
females’ death certificates in the mid-1980s. Deaths from pneumonia
were reported for three female IDUs, and a fourth death was reported
from acute renal failure with notations about narcotics use. The women
were not tested for HIV/AIDS from 1985 to 1987; consequently, none of
these deaths was ascribed to HIV infection or AIDS. Of course, failure to
report an AIDS/HIV diagnosis on a death certificate also occurred before
CDC’s modifications of the AIDS case definition (Centers for Disease
Control 1987, 1992).
The issues of question wording, question order, question context, and
question format are discussed next, and all have repercussions for data
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