Behavioural Surveillance Surveys - The Wisdom of Whores

Strengths and limitations
The goal of most AIDS programs working
with sex workers is an increase in the number
of sex workers who always use a condom
and thus are protected from HIV infection.
The pressure to say “always” may be strong,
and asking about a recent act of sex may give
a more robust measure of levels of condom
use with clients. Consistent condom use with
clients is covered in Female Sex Worker
Indicator 4. The difference between these two
indicators can be useful for program purposes.
What proportion of those who say they used a
condom at last sex also say they are not
regular condom users, for example ? Do any
sex workers who claim to “always” use
condoms with their clients also say that they
did not use one with their last client ?
Since a sex worker typically sees more clients
than vice versa, it is unlikely that there will be
an exact match between condom use reports
from sex workers and from their clients.
In addition, the time reference periods for the
two indicators are very different. However if
both data sets show trends in the same direction,
confidence in this self-reported data is likely
to be strengthened.
Female Sex Worker Indicator 4
Consistent condom use with
clients in the last month
Definition
Numerator :
Number of sex workers who
report always using a condom
with every client in the last
month.
Denominator : Total number of sex workers
surveyed.
Measurement tools
Female sex worker questionnaire
Q406
What it measures
Sex workers typically have a very high
turnover of partners, so even occasional lapses
in condom use can lead to high levels of HIV
transmission from clients to sex workers and
vice versa. Consistent condom use is probably
a more critical goal in this sub-population than
in any other. The indicator is the proportion
of all sex workers surveyed who report using
a condom with every single client in the
last month. For program purposes it should
be disaggregated by type of sex worker
(brothel, based, freelance, licensed, illegal etc.)
where appropriate.
This measure shares the strengths and
weaknesses of other measures of consistent
condom use. Note that the time reference
period is restricted to one month, rather than
the one year used for clients. This is because
sex workers typically have several clients in a
week, and often even in a day. Their ability
to recall condom use in every act of sex over
a longer period with any degree of accuracy
is therefore likely to be limited. In countries
with exceptionally high average turnover of
clients, it may be appropriate to restrict this
reference period to a week. Whichever of the
two is chosen, it is crucial that it be clearly
stated in all use and discussion of the indicator,
and that it be used consistently over time.
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Chapter 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