Behavioural Surveillance Surveys - The Wisdom of Whores

Men Who Have Sex With Men
Indicator 3
Anal sex with multiple partners
in the last six months
Definition
Numerator :
Number of respondents who
report anal sex with more than
one other man in the last six
months
Denominator : Total number of respondents
surveyed.
Measurement tools
Men who have sex
with men questionnaire
Q306
What it measures
Unprotected anal sex is by far the
highest risk behavior for transmission of
HIV among men who have sex with men.
Most interventions in this group aim both to
decrease the overall number of partners and
to increase condom use in all partnerships.
This indicator attempts to measure changes in
anal sex with multiple partners (and therefore
exposure to sexual networks that may carry
the risk of HIV transmission).
How to measure it
In a behavioral survey in a sample of
men who have sex with men, respondents
are asked about sexual partnerships in the
preceding six months. For male partners,
they are asked how many they had anal sex
with. If the response is more than 1,
the respondent enters the numerator for this
indicator. The denominator is all respondents.
Strengths and limitations
Note that the time reference period for this
denominator differs from those used for other
groups. The standard time reference period
for indicators of sexual behavior is 12 months.
The six month period is used because in most
cases where BSS is used in sub-populations
of men who have sex with men, the sampling
strategy tends to focus on cruising areas and
other areas where men congregate specifically
to seek other male partners. This means that
those included in the sample are likely to be at
the higher end of the spectrum of risk behavior,
and to have a high turnover of partners.
Indeed these are precisely the individuals of
greatest interest to HIV prevention programs.
Groups with a high average turnover of
partners are likely to have difficulty recalling
the total number of partners over one year,
the reference period commonly used in
indicators of sexual behavior. The time
reference period is reduced to six months to
provide for more accurate recall. In situations
where rapid assessment shows that a high
proportion of men sampled have very high
levels of sexual behavior, a time reference
period of one month may even be considered
for all indicators of sexual behavior among
men who have sex with men.
One of the difficulties associated with the
sampling methods used for men who have
sex with men is that men who respond to the
HIV epidemic by “cruising” for partners less
often may drop out of the
denominator, because they are no longer
hanging out at the sites where sampling takes
place. The behavior changes that are recorded
by this indicator and others in this set
are therefore likely to underestimate the true
levels of risk reduction in a population.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 9
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