Behavioural Surveillance Surveys - The Wisdom of Whores

Adult Indicator 8
Condom use at last sex with
a commercial partner
Definition
Numerator :
Number of male respondents
who used a condom the last
time they had sex with a
commercial partner
Denominator : Number of male respondents
who have had sex with at
least one commercial partner
in the past 12 months
Measurement tools
Adult questionnaire
Q503
What it measures
This indicator gives an indication of the
success or failure of campaigns to increase
condom use among clients of sex workers.
It measures condom use by men with partners
they consider to be commercial partners.
How to measure it
As with Adult Indicator 6, this indicator is
only relevant to settings where commercial
sex or prostitution is well defined. Men who
report sex with a commercial partner in the
previous 12 months are asked whether they
used a condom the last time they had sex with
a sex worker.
The indicator is the number of men who
report that they used a condom at last sex
with a sex worker, divided by all those say
they have had sex with a sex worker in the
last 12 months.
Strengths and limitations
This indicator is invaluable in tracking
the success of major programs to promote
condom use in commercial sex.
Most AIDS programs aim to increase
consistent use of condoms with sex workers.
Surveys of clients of sex workers will almost
certainly want to ask whether they use a
condom always, sometimes or never during
sex with sex workers over the last 12 months.
However the pressure to say “always” is
strong. Asking about a particular, and recent,
act of sex may give a more robust measure
of levels of condom use in commercial sex.
This measure should therefore be used as
the core indicator. However it is strongly
recommended that programs focusing
prevention resources on increasing condom
use in commercial sex also construct an
indicator of consistent use of condoms in
commercial sex, as described in Adult
Indicator 9. Where both questions are asked,
the “last time you had sex with a sex worker”
the question should precede the “always,
sometimes, never” question.
Where there are several distinct populations
of sex workers with different levels of
perceived risk — for example, brothel-based
sex workers may be thought of as having
riskier behavior than girls in night-clubs —
data may be collected separately for separate
categories of sex worker. This can provide
important information for programming.
For example, men may report very high
levels of consistent condom use in brothels,
but much lower levels with women working
out of night clubs. This may be a warning
signal for a shift of the high prevalence from
one group to another. In constructing the
indicator, however, only the last commercial
sex partner of any sort should be considered.
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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