Behavioural Surveillance Surveys - The Wisdom of Whores

The process of building partnerships and
agreement is fundamental to ensuring that
BSS produces results that are both usable and
used. The ideas and resources contributed by
different partners greatly strengthen the value
of the data collected. But it is worth noting
here that this process can be time-consuming
and occasionally frustrating, especially during
the very first round of BSS. Those managing
the process would do well to plan realistically
for the time and resources consumed by this
preparatory phase.
Public health officials and other government
agencies
BSS is a core part of a second generation
surveillance system for HIV. It is therefore
most likely to occur under the leadership of
the national AIDS program or a national
epidemiological monitoring center. Besides
managing the systems that generate HIV
surveillance data (both behavioral and
serological) public health officials are likely to
be the prime users of the data. The whole
point of surveillance systems is, after all, to
provide information to improve the prevention
and care programs led by these same officials.
It should be noted that this leadership role
does not mean that public health officials
necessarily have to implement the surveys
themselves. Staff in national AIDS programs
are often overworked as it is, and experience
with social and behavioral research may be
limited among program staff. The surveys
and the data analysis may be undertaken by
a variety of institutions, ranging from local
universities to market research firms to
non-governmental development organizations.
But if the results of the data collection are to
meet their needs, program officials will want
to maintain a leading role in overseeing the
choice of respondent groups, indicators, etc.,
as well as in disseminating the data and
lobbying for its effective use.
Public health officials in the national AIDS
program and elsewhere are also well placed
to seek support from other quarters of
government. Often, formal approval for
research on human subjects must be sought
from national authorities, often in a ministry
of science and technology. Various other
ministries may also be able to help facilitate
access to groups to be included in surveillance.
Education officials can help provide a sampling
frame and work to secure head teacher support
for surveys among students, for example,
while the defense ministry might facilitate
access to groups of soldiers.
Agencies that might obstruct progress if
they misunderstand the purpose and goals
of behavioral surveillance should also be
consulted early on. The support of the
interior ministry or the police authorities can
be crucial to the smooth implementation of
BSS among groups such as drug injectors
whose behavior is illegal. Once these
authorities are fully informed of the purpose of
BSS by their colleagues in the health ministry,
they are often in a position to offer constructive
suggestions which will improve the eventual
outcome of the data collection exercise.
Organizations providing services to
communities at risk for HIV
In many countries, the majority of services
for members of sub-populations at especially
high risk of exposure to HIV are provided by
non-governmental organizations (NGOs).
These NGOs have an important contribution
to make in planning BSS activities for two
main reasons.
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C H A PTER 2 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S