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Increasing evidence indicates that sex workers use condoms less consistently with regular (i.e., nonpaying) partners than with clients. Few studies have examined the extent to which these 2 categories are mutually exclusive. In an ethnographic study of women's sex work in Antananarivo, Madagascar, we examined how the meaning of women sex workers’ sexual relationships could shift among 3 different forms of sex work. Condom use was less likely in forms in which the distinction between client and lover (sipa in Malagasy) was fluid. For many sex workers, therefore, relationships they understood to be intimate imparted the greatest health vulnerability. It is important to examine the influence of the meaning of sexual relationships on condom use for HIV prevention. Policy implications for HIV prevention work with sex workers are considered.

Objectives. We conducted a mixed-method study in rural southwestern Bangladesh, a country in which an estimated 730 000 elective pregnancy terminations occur each year, to explore women's and couples’ motivations to terminate pregnancies. Methods. Quantitative data derived from a 1998 cross-sectional survey and a longitudinal demographic surveillance system (1998–2003) were combined with qualitative data gathered through 84 in-depth interviews conducted with 19 couples during 2004–2005. Results. Quantitative results indicated that 11% of couples reported a pregnancy termination in the study period; the rate was highest among couples who reported in 1998 that they wanted no more children (29%). Both wives’ and husbands’ fertility preferences independently and significantly predicted pregnancy termination. Qualitative findings showed that more than half of the participants had attempted to terminate a pregnancy at least once in their lifetime. Conclusions. Our results highlight the importance of collecting data from both partners and the influence of husbands’ fertility preferences on reproductive decisionmaking. The prevalence of reported pregnancy terminations in our population, along with the use of informal methods in termination attempts, highlights the need for continued provision of contraceptives and access to safe and affordable pregnancy termination services in this setting.

Objectives. We compared reports of sexual behaviors given in standard face-to-face interviews with reports given in audio computer-assisted self-interviews (ACASIs) and culturally specific interactive interviews among adolescents in India. We sought to determine which of the interview methods leads to higher reporting of sexual behaviors among economically disadvantaged 15–19-year-olds in urban India. Methods. We conducted a randomized trial in which each participant (583 boys and 475 girls) was assigned to 2 interview methods: face-to-face interview and ACASI or interactive interview. We used matched case–control analyses to assess differences in the individual’s reporting on the 2 methods. Results. Female participants consistently reported fewer sexual behaviors in ACASIs than in face-to-face interviews, whereas male participants’ reports differed according to type of sexual behavior and interview mode. Both male and female participants reported more sexual behaviors during interactive interviews than during face-to-face interviews. Twenty-eight percent of male participants reported having engaged in heterosexual intercourse in interactive interviews, as compared with 20% in face-to-face interviews (P< .01); the corresponding percentages for female participants were 7% and 2% (P Conclusions. Our results showed that young people were more likely to report sexual behaviors in culturally specific interactive interviews than in face-to-face interviews. By contrast, ACASIs did not uniformly lead to higher reporting levels than did face-to-face interviews.

We appreciate the opportunity to respond to the issues raised by Burnie et al. regarding our mixed-method analysis of pregnancy termination in Bangladesh. With respect to ascertainment of pregnancy status, all women within the Sample Registration System (SRS) households are asked to report on their menstrual status during the quarterly visits. If amenorrheic, women are queried as to the possible cause (e.g., use of injectable contraception, suspected pregnancy). If a woman is unsure of her pregnancy status, her record is flagged in the SRS database for follow-up. If her pregnancy is confirmed, she is asked for the date of her last menstrual period. Albeit imperfect, this method is less subject to recall bias as compared with retrospective reporting of pregnancies and pregnancy loss.1,2 A more detailed explanation of the SRS and pregnancy ascertainment are described elsewhere.3,4 Attrition over the study period was relatively low as compared with other longitudinal data sets. The sample was comprised of couples in which both spouses answered the 1998 fertility questions. Of these couples, over 82% remained active through the 5-year study period. Even when comparing the sample women to all women who participated in the 1998 survey (n = 5 273), there were no significant differences (P < .05) apart from a slightly higher mean number of children among our sample (2.45 vs 2.37 children; P value = 0.035). We agree with Burnie et al. that walking distance does not wholly define access. However, given the existing secondary data available for this analysis and literature linking higher mobility with lower fertility among Bangladeshi women,5 we felt walking distance to be the most appropriate available proxy measure to assess the potential physical and psychological barriers for women in accessing health services in this context. During qualitative data collection, there were nightly staff meetings in the field, in addition to further crystallization of study findings by the entire study team through peer review of transcripts and memo-writing on emerging and dominant themes. The themes identified during the fieldwork served as a basis for the results presented. Lastly, we would like to concur with Burnie et al. that this study is not meant to be representative of all of Bangladesh, or even all of rural Bangladesh. Despite limitations, these data shed light on the contextual circumstances of pregnancy termination. We hope that our study prompts further investigation and a more holistic understanding of pregnancy termination within and outside of Bangladesh.