Behavioural Surveillance Surveys - The Wisdom of Whores

Recognizing that HIV surveillance does not,
by itself, meet the information needs of HIV
prevention program planners, UNAIDS, WHO,
FHI and others have developed a new
framework for HIV surveillance. This
framework, known as Second Generation
HIV Surveillance, stresses the need to design
a surveillance system that is appropriate to the
epidemic state of the country, concentrating
surveillance resources on the groups in
which HIV infection is most likely to be
concentrated. It particularly emphasizes the
importance of using behavioral data to inform
and explain trends recorded in HIV infection
in a population, and advocates for the more
extensive use of behavioral data in planning
and evaluating an appropriate response to
HIV. A comprehensive discussion of the new
approach to HIV surveillance can be found in :
WHO/UNAIDS : Guidelines for second
generation HIV surveillance. Geneva, 2000.
This document is available on the internet at
http://www.who.ch.
Uses of behavioral
surveillance
Second Generation Surveillance identifies
several important roles for information that
reliably tracks changes in the behaviors that
spread HIV.
Behavior as an early warning system
Not everyone in the population is at
the same risk for HIV. Risk behaviors are
sometimes concentrated in sub-populations
which vary from place to place. These
sub-populations can often be defined locally
in terms of occupation, migration status,
sexual orientation, age group or other factors.
Behavioral data can indicate which populations
are at risk locally, and can suggest the
pathways the virus might follow if nothing is
done to brake its spread. It can indicate levels
of risk in the general population too, and can
identify sexual links or “bridges” between
groups in the population with especially high
risk of infection, and groups with lower risk.
These sorts of information can act as a
call to arms for people - politicians, religious
and community leaders and people who may
themselves be at risk - signaling that the threat
of HIV is very real even in areas where it is
not yet visible. Such data are a powerful tool
in pressing for action.
Behavioral information to inform program
design
A country monitoring the HIV epidemic is
doing so because it wants to slow the spread
of the virus through effective prevention
programs. Effective prevention is prevention
that enables people to adopt safer behaviors
and protect themselves from the risk behavior
of their partners. But unless something is
known about existing risk behavior, it is not
possible to support relevant safe alternatives.
Behavioral data can indicate who is most
at risk of contracting or passing on HIV
infection, and why. It can help communities
and program planners come up with initiatives
carefully focused on breaking the links in the
chain of transmission in a particular country,
region or group. Without information on HIVrelated
risk behavior, public health officials
and others are unlikely to be able to prioritize
their interventions so that they have the
greatest impact in curbing the spread of HIV.
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C H A PTER 1 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S