Behavioural Surveillance Surveys - The Wisdom of Whores

In some circumstances, public health
officials may wish to use a first round of
behavioral data as a springboard from which
to launch a campaign to lobby for prevention
activities in marginalised groups such as
injecting drug users. But if the prevailing
social or political climate dictates that such
initiatives are bound to fail, it may be best to
drop the group from BSS until circumstances
change. One of the greatest dangers
surrounding HIV surveillance systems
including BSS is that the data generated will
be used to victimize or discriminate against
populations from whom data are collected.
The consultative group planning BSS should
take this possibility into very careful consideration
when choosing respondent groups.
Another danger is that the data will not
be used at all. This is most commonly the
case when influential sectors of society are
in “hear no evil, see no evil, speak no evil”
mode : in other words, in denial about the
existence of certain behaviors in their societies.
Examples come from several African countries
that have refused to allow any data collection
or indeed prevention programming for
school children, arguing that this group is not
sexually active. Some have persisted in this
attitude even when 10 percent of blood
donations from this “low risk” group have to
be rejected because they are infected with
HIV. In the case where inaction is so harmful,
it is worth persisting in trying to build
alliances that will make the collection and
eventually the use of data from these
groups possible.
Political imperatives may affect the choice
of respondent groups in other ways, too.
There may be pressure from politicians to
include (or to exclude) certain geographic
areas or ethnic groups in data collection.
Large donors may also hope to influence the
selection of groups to include populations for
whom they have funded interventions.
Rapid assessment of the feasibility of including
a sub-population group for BSS
Other practical considerations are also
important. A particular group may contribute
to the spread of HIV in a country, but it may
simply not be feasible to define and sample
from the group in a way that would yield any
meaningful information. Criteria necessary to
guide selection of groups include the following:
• It must be possible to define criteria for
being considered a member of the
respondent group
• It must be possible to construct a
sampling frame of locations where the
population can be found
• Interviewers must be able to access
respondents
• Respondents must consent to be interviewed
and be willing to answer personal questions
about their sexual/risk behavior
• There must be adequate numbers of
respondents present to meet sampling
quotas.
Rapid assessment techniques should
establish whether these criteria can be met.
Rapid assessment will include a review of
any existing data or literature about the
sub-population in question, including a press
review. Interviews with group members or
those who provide services to them can
also help broadly to confirm assumptions
about basic levels of risk behaviors in the
sub-population. The ability of interviewers
to approach potential respondents safely,
and the willingness of potential respondents to
discuss their sexual and drug-taking behavior
should also be explored.
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C H A PTER 3 B EHAV I OR A L S U R V EI L L A NC E S U R V EY S