Behavioural Surveillance Surveys - The Wisdom of Whores

Injecting Drug User Indicator 9
Drug injectors using condoms
at last sex with a non-regular
partner
Definition
Numerator :
Number of respondents who
report using a condom the
last time they had sex with a
non-regular partner (i.e. nonspousal
non cohabiting and
non-commercial).
Denominator : Number of respondents
who report sex with any
non-regular partner (i.e. nonspousal
not cohabiting and
non-commercial) in the last
12 months.
Measurement tools
Injecting drug user questionnaire
Q803
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.
While interventions with drug users center
on safer injecting practices, many also actively
promote condom use during sex, aiming to
minimize the spread of HIV from drug users to
the general population. This indicator tracks
changes over time in condom use by injecting
drug users with non-regular partners.
How to measure it
In a survey of injecting drug users, respondents
are asked about sex with non-regular
partners in the last 12 months, and about
condom use at last sex with the most recent
of these partners. The indicator is the number
reporting that they used a condom the last
time they had sex with a non-regular partner,
divided by all those who have had sex with
a non-regular partner in the last 12 months.
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 major
limitation of this measure among drug injectors
is that it does not distinguish between partners
who are themselves injectors and those who
are not. Men and women who inject drugs
are far more likely to be at risk for HIV because
of their injecting behavior than because of
their sexual behavior. Unprotected sex with
another injector is likely to represent only a
small incremental risk of infection for them.
In addition, couples who know that they are
both HIV-infected are unlikely to use condoms
with one another. In this case, unprotected
sex does not represent any risk. It is when
a drug injector has unprotected sex with
someone who does not inject drugs that the
risk of sexual transmission is greatest.
Distinguishing between injecting and
non-injecting partners may not, however,
be practical. People may not know their
non-regular partner’s injecting status.
And inaccuracies in recall are more likely if
people are asked to report condom use with
the most recent non-regular partner who was
not an injector.
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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