Behavioural Surveillance Surveys - The Wisdom of Whores

The standard questionnaires are accompanied
by additional modules that allow for the
calculation of a number of other indicators
that have traditionally been collected in
Knowledge, Attitudes, Behaviors and Practices
(KABP) surveys. These include measures of
risk perception and health-seeking behavior.
These have not been included in the list of
indicators cited here, because experience has
shown that trends over time in these indicators
are difficult to interpret. It is strongly recommended
that more qualitative data collection
techniques that better explain the reasons
behind such attitudes or behaviors be used
in monitoring these types of responses to HIV.
Countries conducting BSS may want to
add a few indicators to the list presented here,
to look at aspects of risk behavior and
prevention which are particularly relevant to
their programs. In selecting and defining such
indicators, care should be taken to ensure that
they meet the above criteria.
The importance of being precise
All the indicators chosen here are very
carefully defined. It is absolutely vital
(in defining an indicator as well as in analyzing
and presenting the data) that the numerator,
the denominator and the time reference
period be precisely defined. The exact
definition for any terms open to interpretation
(such as “commercial sex” or “non-regular
partner”) should also be given.
The denominator, particularly, is a frequent
source of confusion. Some indicators are
calculated using all respondents in the
denominator, while others restrict the denominator
to only those respondents who report a
certain behavior, for example only those who
have had sex in the past year, or only those
who have had sex with a non-regular partner
in the last year. The denominator for similar
indicators sometimes differs according to the
sub-population surveyed. For example,
for reasons that are given below, indicators
of multiple partnerships for young people
include all respondents in the denominator,
one word whereas the equivalent indicator
for adults includes in the denominator only
those who have had sex in the past year.
The standardized indicators have been
developed following long years of trial
(and a fair bit of error) in dozens of countries
and situations around the world. It is strongly
recommended that standard definitions be
used, and changes to the standard definitions
should not be made lightly. However, if there
is a compelling reason to change any parameter
of a standardized indicator, it is absolutely vital
that changes are clearly stated and carefully
defined, so that the indicator can be measured
the same way in future rounds of behavioral
surveillance.
Limitations of indicators
Indicators are just that. They give an
indication of the magnitude or direction of
changes over time. They can not, however,
tell managers much about why the changes
have or have not occurred, and so are not
always useful for diagnostic purposes. For these
purposes, other types of data are needed in
conjunction with the indicators specified here.
In particular, measures are needed of the first
two aspects of programming mentioned above
(was the intervention delivered ? Did it reach
its intended audience). Qualitative data is
also needed to answer the “why?” question.
Alone, the indicators discussed here are not
able to attribute measured changes to a
particular intervention.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 9
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