Behavioural Surveillance Surveys - The Wisdom of Whores

answer the “why” question. And effective
interventions can only be planned if prevention
workers understand what structural, cultural
or other factors stand in the way of adopting
safer behaviors. Qualitative research is not,
however suitable for measuring trends over time.
Project evaluation studies usually do aim
to measure change over time. They often
conduct surveys in the population intended to
benefit from an intervention before it begins,
and then again once the prevention program
is underway or when it is over. These surveys
can yield useful data. But they tend to be a
corollary to an intervention, rather than the
“main event”. The time and effort put into
these surveys (and especially into ensuring
representative sampling) determines how
useful they are to a wider audience. Even
when they are carefully conducted, however,
these surveys tend to be small-scale, linked to
a particular intervention, and rarely repeated
regularly over a long period. For these
reasons, their utility for the purpose of
monitoring the effectiveness of the national
response and planning national or regional
level programs is limited.
Behavioral surveillance surveys
Based on classical HIV and STI serologic
surveillance methods, BSS consists of repeated
cross-sectional surveys of groups whose
behavior may help explain the spread of HIV
and determine prevention needs in a given
country.
The defining characteristic of BSS is
consistency over time. It uses a consistent
sampling methodology, consistent data
collection methods and consistent indicators
in order to track trends in behavior over time.
In order to ensure that trends over time can
be interpreted with confidence, BSS focuses
a lot of attention on sampling strategies.
This approach is designed to yield a maximum
of reliable, usable information for the
investment made.
BSS aims to concentrate attention on
behaviors and sub-populations that contribute
most to the potential spread of HIV. Because
it uses sampling methods other than household-based
sampling, BSS is peculiarly
well-suited to investigating behaviors that
are rare or unevenly distributed throughout
a population, but that may disproportionately
affect the spread of HIV. These behaviors
include drug injection, sex between men,
and commercial sex. This makes BSS an
especially useful tool in monitoring HIV
epidemics in which HIV and related risk
remains concentrated in relatively well-defined
sub-populations.
Just as HIV sero-surveillance systems record
HIV prevalence among clients with sexually
transmitted infections to reflect those at high
risk for infection and among pregnant women
to reflect those at lower risk, so BSS can select
groups to represent different levels of likely
risk behavior. A country might choose one
occupational group — such as migrant mine
workers or the military — thought to be highly
likely to be clients of sex workers, and
another, such as farm workers - thought to
represent those with more average levels of
risk. Table 1 on page 27 illustrates some of
the groups that countries have chosen to
include in BSS to date.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 1
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