Behavioural Surveillance Surveys - The Wisdom of Whores

Men Who Have Sex With Men
Indicator 10
Men who have risky sex with
men and women
Definition
Numerator :
Number of respondents who
have had unprotected sex
with a woman at least once
in the last 6 months, and who
have had unprotected anal sex
with at least one other man in
the last 6 months
Denominator : All respondents.
Measurement tools
Men who have sex with men questionnaire
Q405, Q505, Q604, Q605
What it measures
Anal sex between men carries a relatively
high risk of HIV transmission, especially if
partner turnover is high. But many men who
engage in this relatively risky sexual behavior
also have sex with women. Unless all their
sexual acts are protected by condom use, they
may therefore be putting their female partners
at elevated risk of contracting HIV. This behavior
may be especially likely in societies where
there is no clearly defined “gay” community,
whose members self-identify as homosexual.
How to measure it
In a survey of men who have sex with
men, respondents are asked about their male
sexual partners over the last 6 months, and
about consistent condom use with those
partners. They are then asked about female
partners in the last 6 months, and about
condom use with those female partners.
The numerator is men who report any anal
sex with at least one man in the last 6 months
and do not report always using condoms with
every male partner, and who report sex with
at least one woman in the last 6 months and
do not report always using condoms with
every female partner. The denominator is all
respondents.
Strengths and limitations
This indicator is rather complicated to
construct, since it requires several different
pieces of data : sex with men in the last six
months, consistent condom use with men in
the last six months, sex with women in the last
six months, and consistent condom use with
women in the last six months.
It is not, however, difficult to understand.
It gives a fairly accurate measure of the
proportion of men who have sex with men
who put female sex partners at risk because
of their male-male sexual practices.
This indicator does not qualify as a key
indicator because few if any prevention
programs work to reduce the proportion of
men who have sex with both men and women.
However it is of immense value as part of an
“early warning system”, one of the prime
functions of BSS. The indicator can help to
provide warning of the possibility of spread
from a sub-population in which HIV may
already by concentrated to a wider population
of women and their other male partners.
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