Behavioural Surveillance Surveys - The Wisdom of Whores

Adult Indicator 3
Number of non-regular
partners in the last year
Definition
Option 1 :
Option 2 :
Numerator :
Median number of sexual partners
in the last 12 months who are not
spousal or cohabiting, and who
are not commercial partners
Number of male/female
respondents who have
had sex with more than x
non-regular (i.e. non-spousal,
non-cohabiting and noncommercial)
Denominator : Total number of male/female
respondents
Measurement tools
Adult questionnaire
Q304
What it measures
The spread of HIV depends upon unprotected
sex with people who also have other partners.
Most monogamous relationships are cohabiting,
although the reverse is not necessarily true.
Partners who do not live together — who
have sex only occasionally — are those who
are most likely to have other partners over the
course of a year. These partnerships therefore
carry a higher risk of HIV transmission than
partnerships that do not link in to a wider
sexual network. AIDS prevention programs
try to discourage high numbers of partnerships,
and to encourage mutual monogamy.
This indicator aims to give a picture of the
proportion of the population that engages
in relatively high risk partnerships and that is
therefore more likely to be exposed to sexual
networks within which HIV can circulate.
How to measure it
Respondents are asked whether they have
had sex in the past 12 months, and if so,
whether they have had sex with a spouse or
regular partner, with a non-regular partner,
or with a commercial partner. They are further
asked how many partners they have had of
each type in the previous year. This indictor
is calculated using information about the
second category only. For this indicator the
“threshold” number of non-regular partners
should be defined locally. Since the purpose
of an indicator is to measure changes in risk
behavior over time, it is suggested that this
threshold be derived from the first round of
surveillance. The most appropriate threshold
may depend on the distribution of risk
behavior in a population, as well as on
background levels of HIV prevalence.
Where background HIV prevalence is high
and any non-regular sex carries a high risk
of transmission, the threshold may be set at
the median value recorded during the first
round. In epidemics where the risk of HIV is
concentrated in groups with higher than
average risk behavior, the threshold may be
set higher, say at the 75th percentile. This will
track reductions in risk among those at the
higher risk end of the spectrum.
Where sexual behavior is normally
distributed around the mean, it may be
sufficient to track changes in the median
numbers of non-regular partners.
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C H A PTER 9 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S