List randomization for eliciting HIV status and sexual behaviors in rural KwaZulu-Natal, South Africa: a randomized experiment using known true values for validation.

In this context, LR performed poorly when compared to known truth, and did not improve estimates over direct questioning methods when comparing with known truth. These results may reflect difficulties in implementation or comprehension of the LR approach, which is inherently complex. Adjustments to delivery procedures may improve LR's usefulness. Further investigation of the cognitive processes of participants in answering LR surveys is warranted.