Behavioural Surveillance Surveys - The Wisdom of Whores

Some attempts have in the past been made
to use a broad definition for commercial sex,
such as the exchange of goods and services
for sex. Experience has shown that these
definitions yield information that is hard to
interpret. This questionnaire is designed only
for use with women who sell sex for cash.
Injecting drug users
The questionnaire designed for injecting
drug users contains questions on frequency of
drug injection, syringe and equipment sharing
behavior, cleaning of equipment, and sexual
behavior. It is to be used solely with individuals
who are regular injecting drug users. Often,
this will be defined as anyone who has injected
drugs at least once in the last month.
Men who have sex with men
The questionnaire for this group is to be
used with men who have regular sexual
contact - manual, oral, or anal - with other men.
Since this group can be extremely diverse in
various country settings, the questionnaire will
likely need to be adapted to the local contexts
and cultures of male-to-male sex.
In many of the locations where men who
have sex with men can be sampled, male sex
workers may also be present. However,
because this group engages in commercial
sex, they are fundamentally different than the
general community of men who have sex
with men. Thus, we do not recommend
that they be combined in the same sample,
nor that the same questionnaire be used.
For male sex workers, a different questionnaire
(not included here) should be constructed
which takes into consideration the contexts
of commercial sex.
Overlapping sub-population groups
It frequently occurs that some members of
the above described sub-population groups
engage in additional risk behaviors other
than the ones which define them as a group.
For example, some female sex workers also
inject drugs, some youth also engage in
commercial sex, and some adult males who
might be sampled in a survey focusing on sex
with women also engage in male-male sex.
If the rapid assessment phase points out that
substantial numbers of a sub-population group
engage in these “cross-over” risks, then the
questionnaire should be adapted to reflect this.
Adapting standardized questionnaires
The use of the attached standardized
questionnaires has many advantages.
First, questionnaire development is a difficult
process, and these instruments contain
formulations of questions, time references,
and skip patterns which have been tested and
are known to produce high-quality data.
Second, since these instruments have been
used in numerous settings throughout the
world, their continued use will allow behavioral
surveillance results to be compared internationally
to determine differences in the dynamics
of behavior change and the characteristics of
different population groups.
However, it is still essential to pretest
and adapt survey instruments for every
local setting. This involves translating the
instruments into local languages and using
the appropriate local terminology to ensure
that the original meaning of the question is
not lost. It will also be necessary to conduct
qualitative research and to involve local
members of the sub-populations who can help
with the interpretation of the questions.
B EHAV I OR A L S U R V EI L L A NC E SURV EY S CHAPTER 6
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