Behavioural Surveillance Surveys - The Wisdom of Whores

Injecting Drug User Indicator 8
Drug injectors using condoms
the last time they bought or
sold sex
Definition
Numerator :
Number of respondents who
report using a condom the last
time they bought or sold sex.
Denominator : Number of respondents who
report buying or selling sex in
exchange for drugs or money
at least once in the last month.
Measurement tools
Injecting drug user questionnaire
Q704
What it measures
Drug injectors frequently have sexual
partners who do not inject drugs. Because
of the high HIV prevalence typically found
among injecting drug users, these partners are
at especially high risk of infection through sex
unless a condom is used. They provide a
conduit by which the virus may enter the
larger population of people who are sexually
active but who do not inject drugs. This is
especially true for drug injectors who sell sex,
since they may have a large number of partners.
The risk of passing HIV from a drug
injector to a client is highest when no condom
is used. This indicator tracks changes over
time in condom use by injecting drug users,
by partner type.
How to measure it
In a survey of injecting drug users,
respondents are asked about commercial
partners in the last 12 months. They are
further asked whether commercial partners
were paid or paying, and the timing of the
most recent paying client. The indicator is the
number reporting that they used a condom the
last time they bought or sold sex, divided by
all those who sold sex in the past one month.
Strengths and limitations
For reasons given in the section on sexual
behavior, a cross-sectional measure of condom
use at last sex gives a rather reliable picture of
overall levels in condom use.
The indicator is restricted to commercial
partners for programmatic reasons. While
epidemiologically the risk of a drug injector
passing on HIV infection in sex is not
dependent on partner type, the implications
for the further spread of HIV are substantial.
Low condom use with commercial partners
among drug injectors who support their drug
purchases by selling sex is epidemiologically
more worrying than low condom use with
regular partners, simply because partner
turnover in commercial sex is higher.
Special interventions may be needed to
promote condom use in sex between injecting
drug users and their commercial partners.
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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