Behavioural Surveillance Surveys - The Wisdom of Whores

Injecting Drug User Indicator 6
Injecting drug users with
access to sterile needles
Definition
Numerator :
Number of respondents who
report having access to sterile
needles though pharmacies or
needle exchange programs
Denominator : Total number of respondents
surveyed.
Measurement tools
Injecting drug user questionnaire
Q311A
What it measures
This indicator measures the ease of access
to needles among drug injectors. In countries
where sterile syringes/needles are not easily
available over the counter, this indicator will
act principally as a measure of the coverage
of needle exchange programs.
How to measure it.
Injecting drug users are asked whether they
know where they can get a sterile needle any
time they want one. They are then asked more
specific questions about sources of clean needles.
Those that report that they can easily get
sterile needles any time they want form the
numerator for this indicator. The denominator
is all respondents in the survey.
Strengths and limitations
Changes in this indicator over time may be
very abrupt. If a country changes its policy to
allow for the sale of needles in pharmacies
without prescription (where previously such
sales were forbidden or required a prescription)
this indicator may move from virtually nil to
virtually 100 percent between two survey
rounds. Where this is the case, the indicator
may be dropped from future survey rounds.
Where access to sterile needles through
pharmacies remains restricted, this indicator
will function primarily as a measure of the
coverage of needle exchange programs.
In this case it may be affected by the inclusion
of needle exchange programs as a sample
site for BSS in drug injectors. The higher the
proportion of respondents sampled from
such sites, the higher this indicator will be.
This may not, however, truly reflect high
coverage by the needle exchange program,
but simply that the program provided a
convenient access point to a large number
of drug injectors.
There are many things that affect access
to sterile needles besides simple availability.
Price, opening hours of institutions providing
needles and fear of disapproval or harassment
may limit access to needles even where they
are technically available. These dimensions
of access are not covered in the indicator.
They are better explored using qualitative
survey methods than in a quantitative
behavioral survey.
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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