Behavioural Surveillance Surveys - The Wisdom of Whores

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In sum, collecting behavioral data and HIV status from the same individuals is not recommended in regular surveillance systems. However it is recommended that where serosurveillance occurs in sub-populations such as men who have sex with men, sex workers or drug injectors, attempts be made to draw respondents for behavioral surveillance from the same source population. Where sero-surveys are population-based, this may mean using the same sampling frame. Where they are service based, it may mean taking the catchment area of the service into consideration in the sampling framework for the behavioral surveillance. At a minimum, basic sociodemographic variables should be collected from both groups in order to determine similarities and differences between the two to the extent possible. Attributing behavior change to a prevention intervention While behavioral data can help document changes in behavior, it is important to realize that they can not draw a direct causal link between a particular intervention and a particular level of behavior change. Most people are exposed to many sources of information and make decisions based on many, criteria. Information or activities provided as part of a prevention program will contribute to what people decide and how they behave, but there may be many other factors in the equation. Behavioral surveillance data alone are rarely able to isolate and attribute change to a single element. Behavioral data such as that generated by BSS can, however, be used together with other types of data to infer a plausible effect of prevention efforts. For example, process indictors might show that 50 prime-time spots encouraging young men to use condom in commercial sex had been aired on TV in a six month period between two rounds of BSS. Output indicators might show that condom sales had doubled in that period. BSS among military recruits might register a 50 percent rise in condom use at last commercial sex, and BSS among sex workers might register a 10 percent rise in condom use with last client. In addition, health facility statistics might record a significant drop in STI cases treated in the last month, compared with the same period a year earlier. It would not be possible from this to attribute the safer behavior directly to the TV campaign. But the consistency of the indicators would surely allow policy - makers to infer that their prevention efforts (which of course include the availability of condoms and of STI treatment services to support the messages of the media campaign) were reducing the risk of HIV infection in young men and their future sex partners. Other research complements BSS BSS is not meant to answer every risk behavior question about every target group. In fact, BSS should be limited to only a few target groups with a questionnaire including only key introductory and behavioral questions. In-depth information about target groups, the evaluation of specific interventions, and relationships between several behavioral variables are better obtained through quantitative and qualitative behavioral research specifically designed to answer these questions. They are necessary adjuncts to behavioral surveillance which together form a comprehensive package of monitoring and evaluation. B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 1 9
GUIDELINES FOR REPEATED BEHAVIORAL SURVEYS IN POPULATIONS AT RISK OF HIV C H A P T E R setting up bss: steps in the process 2 SETTING UP BSS: STEPS IN THE PROCESS ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ • Building partnerships • Decisions on methodologies • Implementation planning • Analysis issues • Dissemination
Page 1 and 2: BEHAVIORAL SURVEILLANCE SURVEYS GUI
Page 3 and 4: Family Health International (FHI) H
Page 5 and 6: Chapter 7 Analysis and interpretati
Page 7 and 8: 3. Choosing populations for behavio
Page 9 and 10: G UIDELINES FOR REPEATED BEHAVIORAL
Page 11 and 12: Recognizing that HIV surveillance d
Page 13 and 14: Different approaches to collecting
Page 15 and 16: The principal rationale for focusin
Page 17: It is not possible to validate data
Page 21 and 22: The process of building partnership
Page 23 and 24: Funders of HIV prevention activitie
Page 25 and 26: What is to be measured ? Indicators
Page 27 and 28: Step 7 : Constructing a sampling fr
Page 29 and 30: Step 12 : Data collection and super
Page 31 and 32: choosing population groups GUIDELIN
Page 33 and 34: the spread of HIV. For this reason,
Page 35 and 36: In some circumstances, public healt
Page 37 and 38: GUIDELINES FOR REPEATED BEHAVIORAL
Page 39 and 40: The majority of sub-populations of
Page 41 and 42: In the end, the issue boils down to
Page 43 and 44: In looking at behaviors of hard-to-
Page 45 and 46: Maps derived from program planning
Page 47 and 48: Selecting primary sampling units (c
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Page 51 and 52: If there is no reason to believe th
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Page 55 and 56: Implications of alternative samplin
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Page 59 and 60: Table 6 : Sample size requirements
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Page 65 and 66: Other measurement issues for BSS Th
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5 Weighting in multi-stage sampling
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Figure 6 : Procedures for calculati
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Calculating weights from sampling p
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Calculating standard errors with mu
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6 Adapting and using questionnaires
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Some attempts have in the past been
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Informed consent Confidentiality an
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GUIDELINES FOR REPEATED BEHAVIORAL
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Recommended Methods of Statistical
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where n is the sample size in the d
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Table 2 : Reported number of non-re
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False conclusions: the danger of co
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Analysis of trends in behavior over
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Changes in sampling methodology ove
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8 Using the data collected to impro
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Improving prevention programs As a
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Finally, information about HIV and
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Figure 9 : HIV and STD prevalence,
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9 Indicators This guide identifies
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The standard questionnaires are acc
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INDICATORS Page INDICATORS FOR YOUT
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INDICATORS Page INDICATORS FOR MEN
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KEY INDICATORS What follows is a fu
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The indicator uses promoted data. O
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To be counted the numerator for thi
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Strengths and limitations Some meas
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Adult Indicator 5 Consistent condom
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Adult Indicator 7 (men only) Number
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Adult Indicator 9 Consistent condom
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Adult Indicator 11 Population seeki
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Adult Indicator 12 Exposure to inte
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Youth Indicator 2 No incorrect beli
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Youth Indicator 4 Youth sexually ac
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Youth Indicator 6 Number of sexual
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Youth Indicator 8 Consistent condom
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Youth Indicator 10 Commercial sex a
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Youth Indicator 14 Exposure to inte
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Female Sex Worker Indicator 2 No in
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Female Sex Worker Indicator 5 Sex w
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Indicators for men who have sex wit
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Men Who Have Sex With Men Indicator
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Men who have sex with men Indicator
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Indicators for injecting drug users
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Injecting Drug User Indicator 3 Inj
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Injecting Drug User Indicator 8 Dru
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Injecting Drug User Indicator 10 Dr
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Suggested Reading Brown T, Sittitra
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QUESTIONNAIRE For Adult Target Grou
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The ADULT questionnaire includes th
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FHI 1999 HIV/AIDS/STD BEHAVIORAL SU
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POSSIBLE ADDITIONAL QUESTIONS Commu
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STD Treatment seeking behaviors No.
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STD Treatment seeking behaviors (co
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QUESTIONNAIRE For Unmarried Male An
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The YOUTH questionnaire includes th
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No. Questions and filters Coding ca
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Stigma and Discrimination No. Quest
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FAMILY HEALTH INTERNATIONAL (FHI) H
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STD Treatment seeking behaviors No.
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STD Treatment seeking behaviors (co
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QUESTIONNAIRE For Men Who Have Sex
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The MSM questionnaire includes the
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STD Treatment seeking behaviours No
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No. Questions and filters Coding ca
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QUESTIONNAIRE For Injecting Drug Us
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This questionnaire includes the fol
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EXAMPLE OF SUPERVISORS’ AND INTER
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A “take-all” approach is to be
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• To probe for additional informa
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Part B: How to use the Long Distanc
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An example of a question for which
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Part C: Section-by-section review o
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Q109. If the respondent says he/she
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it is asking if the respondent has
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Section 5 : Non-regular partners Q5
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Q706 : This question determines the
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Q910 - Q912 : Knowledge of maternal
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in riskier behavior (i.e., not usin
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Section 5 : Non-paying partners Que
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3 APPENDIX WORKING EXAMPLES OF SAMP
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For the purposes of the BSS, the ke
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The second stage sampling procedure
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Notes: 1. It may not always be poss
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The information from the mapping ex
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In Figure 3, clusters were chosen b
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Fieldwork assignments when the “t
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Figure 4 : Example of targeted snow
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In some settings it may not be acce
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Figure 6 : Steps in using the segme
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Figure 9 : Map of hypothetical samp
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In-class sampling of school youth T
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Alternative to “in-class” sampl
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found at the various locations at d
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What should be done if, even after
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FIELDWORK FORMS The following set o
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Form I Cluster Selection Sheet (Pro
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Form 2 Cluster Selection Sheet (Equ
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Form 3 Assignment Information Sheet
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Form 4 Cluster Information Sheet Su
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TABLE OF CHI-SQUARE STATISTICS AND
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Step 2 : Calculate the expected num
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Behavioural Surveillance Surveys - The Wisdom of Whores

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