Behavioural Surveillance Surveys - The Wisdom of Whores

One example of successful mapping
comes from a rural area of Maharashtra, in
India. Investigators conducting an exercise
to map female sex workers by working with
community level government workers, such as
village level workers and health workers to
identify initial contacts and links with sex
workers. Using those links, they were able to
gather information to identify the villages and
towns where commercial sex activities took
place. They also spoke to other types of key
informants, such as young people, to validate
the information they got from the sex workers.
As their “snowball” technique of identifying
new locations rolled forward, they were
eventually led to border towns, and also
discovered the importance of weekly markets
as a focal point where female sex workers in
rural areas gather.
Members of the community as partners
in mapping
Care must be taken in mapping members
of sub-populations engaged in illegal or
stigmatized activities. Commercial sex workers,
injecting drug users and men who have sex
with men all fall into this category. Mapping
of these groups requires extensive rapport and
trust-building which can best be achieved by
working with members of the sub-population
as part of the mapping team. Confidentiality
of the information, with very limited circulation
of the maps is also crucial. Since the mapping
stage is often a first point of contact between
survey teams and members of the respondent
populations, surveillance officers should
always come prepared to explain what they
are doing, why, and how the results of their
work will be used to benefit the community
in question.
NGOs and service providers as partners
in mapping
Non-governmental organizations (NGOs)
who provide services to the sub-population of
interest are often crucial partners in successful
mapping exercise. In some instances, NGOs
who have been working for many years with
a target population may have already created
maps of their “catchment” area. One danger
of working with NGOs as contact persons is
that the association of a research team with an
NGO can bias data. This is especially true if
the NGOs tends to lead surveillance officers to
the people or sites that are the beneficiaries of
their intervention programs. If the services
provided include effective HIV prevention
services, then these respondents may be
expected to have lower levels of HIV-related
risk than other potential respondents in the
sub-population, who have not been in contact
with the prevention program. In addition,
beneficiaries of NGO programs may perceive
that the investigators are in cooperation with
the NGO, and therefore be more likely to give
the “expected” responses in a behavioral
survey, instead of telling the truth.
Police as partners in mapping
In some cases, police officers have helped
in mapping exercises. This is most common
in surveys of sex workers. While the
support of the police for survey activities
can be important in ensuring success, it is
preferable that this support remains passive.
For example, it is a great help to have police
officers commit not to harass individuals
contacted by the survey teams. It may be less
helpful to have them actively involved in
mapping, however, since association of the
survey team with law enforcement authorities
may greatly increase the refusal of respondent
group members to participate in the survey.
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