Behavioural Surveillance Surveys - The Wisdom of Whores

Countries or regions where HIV is very
uncommon are in a particularly interesting
situation. Many countries is this situation
have not felt the need to invest resources in
collecting behavioral data, assuming that if the
virus is largely absent, risk behavior must also
be limited. However, it is exactly at this point
of the epidemic that behavioral data can act
most effectively as a warning system. Where
behavioral data and other indicators such as
STI or hepatitis B prevalence show that people
are having unprotected sex with multiple
partners or are sharing injecting equipment,
it may simply be a matter of time before HIV
follows. Almost inevitably in these situations,
if HIV surfaces it will do so first in those
groups whose behavior carries a high risk of
exposure to the virus. Behavioral surveillance
should therefore be restricted to those groups.
Just as there are groups that are important
to survey in different epidemic states, it is
important to point out that certain groups
are inappropriate for behavioral surveillance.
For example, it makes little sense to include
pregnant women or STI clients in behavioral
surveillance, for reasons given in the section
on linking behavioral and serological data on
page 8.
Since social circumstances change over
time, countries need constantly to re-evaluate
the existence and importance of different
sub-populations. In Eastern Europe, for
example, rapidly changing social circumstances
had by the mid-1990s led to an epidemic of
injecting drug use unimaginable just a few
years earlier. Similarly, in parts of China,
economic growth is giving rise to increased
internal migration, a rapid resurgence of the
sex industry and an increase in STIs.
Other factors affecting the choice of respondent
groups
It is rare that respondent groups are chosen
purely on epidemiological grounds, and
rightly so. Other factors, led by prevention
efforts, must come into play. As mentioned in
the introductory chapter, there is no point
setting up a behavioral surveillance system
unless a change in behavior is expected.
And while social circumstances may indeed
affect behavior, the primary engine for
behavior change should be HIV prevention
efforts. Unless such efforts are in place or
planned, behavioral surveillance is a waste
of time and money.
In certain countries where little behavioral
information is available, or target populations
are not clearly defined, BSS might include
an initial pilot phase with more in-depth
formative research e.g. attempting to better
characterize sex worker clients. Alternatively,
the pilot phase may be built into the first
round of data collection, with multiple
populations included, some of which may
be dropped in later rounds, or included in
alternative waves.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 3
25