|Meeting the Behavioural Data Collection Needs of National HIV/AIDS and STD Programmes (Implementing AIDS Prevention and Care Project - Joint United Nations Programme on HIV/AIDS - United States Agency for International Development, 1998, 41 p.)|
One reason more behavioural data has not been collected in the past is that many people are deeply skeptical about the validity of self-reported data on sexual behaviour. "Everybody lies about their sex lives," the reasoning goes, "so why bother asking?" The same was said of asking about contraceptive use just 20 years ago, but fertility and reproductive health surveys are now routinely conducted on every continent. The likelihood that people will lie about their sexual behaviour appears to increase as more stigma is attached to this behaviour. Extramarital sex for women carries more stigma in most societies than extramarital sex for men, for example, which accounts for greater underreporting of this behaviour by women than by men.
Growing experience in collecting data on sexual behaviour indicates that people do not always lie. They are, however, more likely to tell the truth in some situations than in others. The extent to which people answer questions about sex openly and truthfully depends on the setting of the question. Are privacy and confidentiality assured? Is the interviewer sympathetic and of the same sex and age bracket as the respondent? Are questions nonjudgmental? The long list of factors potentially biasing response is well known in the social sciences. Questions on sexual behaviour are simply at the most sensitive end of the spectrum of behavioural data collection.
Obviously it is not possible to validate data on sexual practices through direct observation. It is, however, possible to triangulate them with data from other sources to see whether the picture presented is consistent and credible. For example, process evaluation data on condom sales, the intensity of peer education, or the quality and coverage of media campaigns can be combined with an analysis of behavioural outcome data to provide an understanding of the process through which interventions achieve effects. In addition, results from behavioural surveys should be analysed together with findings from qualitative evaluation research (e.g., focus group discussions, key informant interviews, and rapid ethnographic studies) carried out in subsamples of surveyed target populations.
Moreover, those tracking the HIV epidemic may be less concerned with the exact level of risk behaviour in a population than with trends in those behaviours. Behaviour trends are of great interest in explaining changes in HIV prevalence. Even where there is misreporting, repeated behavioural surveys will show changes in trends over time, provided that the magnitude or direction of misreporting does not change significantly.
There is now enough experience in collecting data on sexual behaviour to suggest that it can be successful in most circumstances, providing certain basic criteria are met. Questionnaires must be carefully designed and tested to balance the needs of the local community with the interests of regional and international standardisation. Interviewers must be carefully selected, well trained, and prepared to communicate with respondents in a way that builds trust and avoids judgement. Interviews should take place in private, and respondents must be sure that the information they give will remain confidential.
Finally, when assessing behavioural change it is important to realise that prevention programmes have to be implemented for sufficient amounts of time and on a large enough scale to have an impact on personal behaviour, social norms, communities, and on the epidemic.