Behavioural Surveillance Surveys - The Wisdom of Whores

Injecting Drug User Indicator 7
Injecting drug users selling
sex
Definition
Numerator :
Number of respondents who
report selling sex for money
or drugs at least once in the
last month.
Denominator : Total number of respondents
surveyed.
Measurement tools
Injecting drug user questionnaire
Q702
What it measures
This provides a similar measure to the
measure of injecting drug use in female sex
workers, but from a different perspective.
In most countries, drug injection carries a
higher risk of HIV transmission than any other
behavior, and HIV prevalence among injecting
drug users is often higher than in any other
sub-population. If injecting drug users sell
sex to non-injectors to pay for their drugs,
then they may put those sexual partners at
very high risk of infection. The sale of sex
by drug injectors to large numbers of partners
has a greater potential to spread HIV from
injecting to non-injecting populations than
any other behavior. The proportion of drug
injectors regularly selling sex is therefore of
central interest to HIV prevention workers.
If the sale of sex is only occasional, then it
will have little overall impact on the spread of
HIV from injecting to non-injecting populations.
Drug users who regularly sell sex and who
therefore have the potential to spread HIV
to a larger number of partners are of greater
interest than those with only occasional
commercial partners. The relatively short
time-frame of one month for the sale of sex
will capture a higher proportion of injectors
who sell sex regularly than a longer time frame.
How to measure it
Respondents are asked about different
categories of sexual partners over the past
12 months. Those who report a commercial
partner are questioned about whether they
bought or sold sex, or both in the past one
month. Those who report selling sex within
the last month form the numerator of the
indicator. The denominator is all respondents.
This indicator can be used for either male
or female samples of injecting drug users,
but should be reported separately for each.
Strengths and limitations
This gives a good idea of the “overlap”
between drug injectors and sex workers, and
therefore of the potential for HIV to spread
from injecting to non-injecting populations.
It does not, however, distinguish between
relationships in which condoms are used
and those in which condoms are not used.
If condoms are used by drug injectors selling
sex, then the risk of an infected injector
passing HIV on to a sex client is reduced.
This dimension is covered by Drug Injecting
User Indicator 8.
High levels of this indicator act as a warning
of the potential spread of HIV from drug
injecting to non-injecting populations, and
argue for strong efforts to increase safe sexual
behavior as well as safe drug injecting behavior
in sub-populations of drug injectors.
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C H A PTER 9 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S