Behavioural Surveillance Surveys - The Wisdom of Whores

Adult Indicator 6 (men only)
Commercial sex in the last year
Definition
Numerator :
Number of male respondents
who have had sex with a
female sex worker in the
past 12 months
Denominator : Total number of male
respondents
Measurement tools
Adult questionnaire
Q304
What it measures
In heterosexual epidemics, the initial focal
point of infection is very often among sex
workers and their clients. Those clients then
spread infection to their wives and girlfriends
in the general population, as well as to other
sex workers. In such situations, AIDS programs
often focus on trying to reduce the proportion
of men having sex with sex workers, as well
as increasing condom use in these encounters.
This indicator measures progress towards the
first of these goals.
How to measure it
This indicator is intended ONLY for
countries with well-defined populations of sex
workers. It will most often be asked in BSS
among groups of men who fit the profile of
clients of sex workers (the military, truck
drivers etc). Men are asked directly if they
have had sex with a commercial partner in the
previous 12 months.
While there may be several different types
of definable sex workers in a given country,
each with different perceived levels of risk,
all these groups should be combined into an
indicator of commercial sex use for monitoring
and evaluation purposes.
Strengths and limitations
This indicator is useful in concentrated
heterosexual epidemics in countries where
commercial sex (and especially brothel-based
sex) is common, and where a sex worker has
a clearly defined role. This means it is most
likely to be used in parts of the world where
commercial sex has played a dominant role in
the epidemiology of HIV, e.g. many countries
in Asia.
Attempts to collect and analyze data using a
wider definition of commercial sex (questions
such as “Have you given or received money or
gifts in exchange for sex?”) have not yielded
useful information. In epidemic terms sex
workers are of interest because they have a
high turnover of partners and therefore have a
high probability of being exposed to infection
and passing on infection. In many cultures,
this is true of only a fraction of the people
who have “received money or gifts in exchange
for sex”. If there is no locally specific term for
prostitution, the chances are that this indicator
is not relevant to the program. It should not
be used in these situations.
The indicator is also of limited use in very
high prevalence epidemics, since differences
in risk associated with sex with a sex worker
compared with any other casual partner may
not be very substantial.
Some men may respond to the HIV epidemic
by reducing, but not eliminating, their purchase
of sex. This indicator is not sensitive to these
changes. It should be interpreted in conjunction
with Adult Indicator 7.
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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