Behavioural Surveillance Surveys - The Wisdom of Whores

Men who have sex with men
Indicator 5
Condom use at last anal sex
with a non-commercial partner
Definition
Numerator :
Number of respondents who
report condom use at last anal
sex with a non-commercial
male partner
Denominator : Number of respondents who
report anal sex with at least
one non-commercial partner
in the last 6 months
Measurement tools
Men who have sex
with men questionnaire
Q503
What it measures
The single most common intervention
among men who have sex with men is the
promotion of condom use during anal sex.
This indicator measures progress towards
increasing the proportion of acts of anal sex
that are protected against HIV transmission.
It focuses on the last act of anal sex for reasons
similar to those given in Adult Indicator 4.
The indicator measures condom use by the
insertive partner during the last anal act, but
because details of the sex act may not be
known, the respondent is asked whether he
or his partner used a condom. A separate set
of indicators (8 and 9) measure condom use
specifically with commercial partners.
How to measure it
Respondents are asked about sexual
partnerships with men in the preceding 6
months, about anal sex within those
partnerships, and about condom use at last
anal sex.
The numerator is the number of men
reporting that a condom was used the last time
they had anal sex with a non-commercial partner.
The denominator is all men who reported
having anal sex at least once in the previous
6 months with a non-commercial partner.
Strengths and limitations
The most serious limitation of this measure
is that it does not distinguish between regular
and non-regular partners and that information
about sero-status is not known. Many couples
who know their sero-status and are seroconcordant
may choose not to use condoms
within their regular partnership. Provided
they use condoms in any sex with other
partners, this represents no increased risk of
transmission within the partnership. Where
non-use of condoms within stable partnerships
is common, the indicator will suggest higher
levels of risk than actually exist.
However, defining “regular” partnerships
in the context of men who have sex with
men is fraught with difficulty, particularly
in communities where male-male sex is
clandestine. The fact that most BSS sampling
methods among men who have sex with men
result in sampled at the high-risk end of the
behavioral spectrum means that even though
some men will have regular partners, a high
proportion of most recent sex acts are likely
to have been between people who are not
stable, monogamous partners and are therefore
exposed to the risk of contracting or passing
on HIV. Condom use at last anal sex with
non-commercial partners probably gives a
good indication of overall levels and trends
of protected and unprotected sex in these
higher-risk populations of men who have
sex with men. For more specific condom use
information on commercial vs. non-commercial
partners, Indicator 8 should be used.
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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