Behavioural Surveillance Surveys - The Wisdom of Whores

The principal rationale for focusing on
populations with higher-than average risk
behavior is that they contribute disproportionately
to the spread of HIV. Early prevention
efforts are often focused on these groups.
BSS in these sub-populations can help
ascertain whether the level of risk behavior is
changing following HIV prevention efforts.
By investigating sexual links with others
outside the sub-population with high risk
behavior, BSS can help to gauge the likelihood
that the virus will spread widely into a broader
population. But a focus on populations with
higher-than average risk has other advantages,
too. It generally enables statistically significant
results to be achieved with relatively small
samples. This keeps costs down, and means
that it is possible to repeat surveys with
greater frequency than larger, more costly
household based surveys.
Frequency of data collection
HIV sero-surveillance systems typically
collect and publish data on an annual basis.
For behavioral data collection, frequency is
dictated by several factors. While cost and
complexity are often cited, one other factor
is at least as important : prevention programming.
In the absence of any prevention
programming, HIV sero-surveillance systems
are likely to record a change in HIV prevalence
over time, and it is more than likely to be a rise.
The same is NOT true of behavior. If no HIV
prevention programs are in place, it is unlikely
that sexual or drug-taking behaviors will
change over time. If they do change in
response to general societal trends such as
urbanization, these changes tend to be slow
and incremental.
Where there are no HIV prevention efforts,
an initial round of surveys may be justified in
order to provide information that will feed in
to the design of future programs. But unless
such programs are implemented, changes in
behavior can be expected to be minimal, and
regular surveillance can hardly be justified.
If, on the other hand, a strong national
prevention effort is put in place, then it is
definitely worth conducting regular behavioral
surveys to monitor changes in behavior. How
regular depends partly on the strength of the
prevention effort, partly on the population
being monitored, and partly on the capacity
and willingness of a country to use the data
generated to improve prevention efforts.
Behavior in the general population tends to
change more slowly than in a tightly-knit
community of people who interact frequently.
Many of the sub-populations at high risk for
HIV infection fall into the latter category.
In addition, effective behavior change
interventions potentially have a greater effect
on these sub-populations than on the general
population. The higher the level of risk at
the outset, the further it has to fall. In general,
it is recommended that behavioral data be
collected every four or five years in the general
population, and every year in sub-populations
among whom HIV prevention initiatives are
most concentrated. Training a core of people
in the standard methods used in BSS will
allow for this regular data collection to be
conducted in a way that ensures data that
reliably describe changes in HIV-related
behaviors over time.
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C H A PTER 1 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S