Behavioural Surveillance Surveys - The Wisdom of Whores

If successful prevention initiatives contribute
to new norms of safe behavior, annual data
collection may no longer be needed. While
less frequent data collection will save cash, it
also bears a cost. Annual data collection feeds
into programming, providing information for
the constant re-evaluation of prevention
needs. Undertaking the exercise regularly
maintains skills and capacity within local
institutions. And regular publication of this
information has the added advantage of
keeping HIV prevention needs in the public
eye, and on the agenda of policy-makers.
The cost of BSS
The cost of collecting behavioral data varies
greatly from country to country and depends
on the number of respondents, the geographic
coverage, the sampling design, and the
frequency and methods of data collection.
Nationally-representative household surveys
are typically the most expensive, costing
around US$250,000 in a developing country of
30 million people. Where other information
are being collected simultaneously, these costs
can be shared with other users such as maternal
and child health programs.
BSS are less expensive (partly because
sample sizes are much smaller and geographical
coverage more limited). They tend, however,
to be more frequent. Initial rounds of BSS,
which may include formative research to
determine the most appropriate population
groups, and extensive training and mapping
work, are likely to be more expensive than
subsequent rounds. As BSS becomes a routine
part of monitoring and evaluation of the
national response to HIV, costs drop because
more experience is gained about how to
efficiently sample and interview sub-population
groups.
Behavioral data collection is generally a
fairly resource-intensive business, and it is
especially heavy on human resources. But if
the results of the data collection are combined
with other elements of a surveillance system to
improve programs that successfully prevent
HIV or minimize its impact, these costs are
more than justified. Set against the costs of
behavioral data collection are the economic
benefits of targeting prevention activities
most effectively. This would not be possible
without a systematic and reliable way of
tracking trends in risk behavior over time,
such as that provided by BSS.
Issues and limitations in
behavioral data collection
Validity of self-reported data about sex and
drug-taking
One reason there has not been more
behavioral data collected in the past is that
many people are deeply skeptical about the
validity of self-reported data on sexual
behavior or illegal activities such as drug
injection. Growing experience in collecting
data on sexual behavior indicates that people
do not generally lie. They are, however, more
likely to tell the truth in some situations than
in others. The more stigmatized the behavior,
the more likely people are to lie about it.
The extent to which people answer questions
about sex openly and truthfully also depends
on the setting of the question. Are privacy
and confidentiality assured ? Is the interviewer
sympathetic, and of the same sex and age
bracket as the respondent ? Are questions
non-judgmental ?
B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 1
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