Behavioural Surveillance Surveys - The Wisdom of Whores

Sometimes it is helpful to work with NGOs
or community groups who may already be
involved in doing interventions with sex
workers, to help gain entry. If these groups
are already trusted by the sex workers, working
through them can help improve participation
and cooperation with the survey. If that
option is not available, the sex workers themselves
may be the best “emissaries” in terms
of helping make contact with the population
and ensuring their participation.
A word of caution: Regardless of how
mapping of sex workers takes place, whether
it be for establishment-based or floating sex
workers, and whether or not snowball sampling
is used, utmost care must be taken to respect
the privacy and confidentiality of those involved
in the survey. In most situations, trust can
only be built by working through NGOs or
members of the community themselves, and
building rapport requires time and patience.
Injecting drug users (IDU)
Of the groups to be covered by target
group surveys, undertaking surveys among
(IDU) may well be the most difficult. Among
the problems likely to be encountered are
difficulties in locating sufficient numbers of
IDU and in obtaining cooperation in providing
the information requested. There is an absolute
need to safeguard the identity, location and
confidentiality of anyone cooperating in the
effort to obtain data from potential respondents.
The protection of the identity of the respondents
must be ensured as well. Potential danger to
the respondents, as well as to the interviewers
should be taken into account before attempting
to carry out these surveys.
With regard to sampling, it is unlikely
that IDUs will tend to congregate in certain
locations in sufficient numbers for a cluster
sampling approach to be effective. However,
in some settings it may be possible to identify
areas of cities where higher than average
concentrations of IDU may be found.
For example, in HIV/AIDS-related research in
San Francisco, USA, it has proven feasible to
identify neighborhoods/districts with significant
numbers of IDU from key informant interviews
and consultations with police and medical
authorities. However, even if a sufficient
number of such areas can be identified, it will
still be necessary to identify the different social
networks operating. Accordingly, the targeted
snowball sampling approach can be a feasible
alternative in most settings.
Figure 4 provides an example of the use of
the targeted snowball sampling approach for
collecting survey data on IDU.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S APPEN DI X 3
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