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close this bookMeeting 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.)
close this folder6. Recommended mix of data collection methods
View the document(introduction...)
View the document6.1 Stages of the HIV epidemic
View the document6.2 Behavioural data collection in a low-level epidemic
View the document6.3 Behavioural data collection in a concentrated epidemic
View the document6.4 Behavioural data collection in a generalised epidemic

6.3 Behavioural data collection in a concentrated epidemic

In a concentrated epidemic, the virus may remain confined to circles of people with higher-risk behaviour because there are few links between those populations and the general population. It May remain concentrated because there is very little risk behaviour in the general population. Or links and generalised risk behaviour may exist, but HIV may not have infected enough individuals to result in explosive growth. In that case, it may be just a matter of time before the epidemic becomes generalised. Determining which of these situations is the case and designing and measuring the success of the appropriate interventions are the key purposes of behavioural data collection in a concentrated epidemic.

At the concentrated stage of the epidemic, it is recommended that countries continue serosurveillance among the groups in which infection is concentrated and begin monitoring HIV in the general population, especially in young people. Behavioural data collection will increase the usefulness of this serological data.

Preliminary assessment in populations with higher risk

Because concentrated epidemics affect more people and present a greater risk to a country than low-level epidemics, there is an even greater likelihood that the data required for preliminary assessment of risk behaviour in the country will already be available. If it is not, the same steps outlined for countries with low-level epidemics should be followed.

Behavioural monitoring: populations with higher-risk behaviours

In a low-level epidemic, the frequency of behavioural surveys in populations with higher-risk behaviours will depend on the prevention activities carried out in that community (and may be guided by changes observed in serosurveillance). In a concentrated epidemic, by contrast, behavioural data should be collected much more systematically. Surveys in selected population groups with higher-risk behaviour should be designed to collect representative data annually or biannually depending on available resources.

The qualitative research performed in the preliminary assessment stage may identify definable groups that overlap extensively with both the general population and populations with higher-risk behaviours. If so, programme planners may consider adding these groups to those included in the targeted behavioural survey system.

Behavioural monitoring: general population

General population surveys are recommended in all concentrated epidemics. As in low-grade epidemics, they should aim to identify what proportion of the population has sex with members of identified groups with higher-risk behaviour and which risk behaviours are most likely to lead to HIV infection.

In concentrated epidemics, household-based surveys can help explain increases in HIV prevalence seen in sentinel serosurveillance. Designers of these surveys should bear in mind the location and population served by sentinel sites and should sample in geographical areas with key HIV sentinel sites. In order to monitor trends over time, it is recommended that general population surveys be repeated every four to five years.

Table 5. BEHAVIOURAL DATA NEEDS AND METHODS IN A CONCENTRATED EPIDEMIC

DATA NEEDS

METHOD

QUESTIONS ANSWERED

FREQUENCY

DURATION*

Preliminary assessment
(if not yet done or if it needs to be broadened- geographically or in other groups)

Review existing data

What is already known? What are the gaps in current knowledge?

One time



Rapid assessment of risk behaviours

Which high-risk behaviours are driving the epidemic in this country?

One time

3 months


Mapping of at-risk populations

Where do people engage in risk behaviour? How many people are associated with each site?

Repeated if survey data shows population or behavioural shift

1 month


Qualitative research

What particular behaviours must change? Is there resistance to change? What are links with general population?

One time

2 months

Behavioural monitoring

and

Explaining trends in HIV prevalence

Repeated surveys in populations with high-risk behaviour

How widespread is risk in high-risk-behaviour groups? How common are links with the general population? How do these behaviours change over time?

Annually/biannually

3-6 months


Repeated surveys in the general population Sampling with emphasis on geographical areas with key HIV sentinel sites

What proportion of the general population has sex with someone with risk behaviour? Which behaviours put them at risk?

Every 4-5 years

6-9 months


Repeated surveys in young people Sampling with emphasis on geographical areas with key HIV sentinel sites

What are the risk behaviours among young people? At what age do they begin? How do they change over time? Do trends in self-reported risk behaviour correlate with observed changes in HIV prevalence (e g, explaining transition to generalised epidemic)?

Every 2-3 years

3-6 months

Behavioural monitoring: young people

Young people are particularly vulnerable and are the key to the future course of the HIV epidemic. They are an essential focus for prevention messages in every sexual health programme. Since most new infections are in young people, modest changes in behaviour in this age group may have a significant impact on the epidemic. It is recommended that their knowledge, attitudes, and sexual behaviour be monitored once there is a concentrated epidemic.

In general, it is recommended that young peoples behaviour be studied in household-based surveys, supplemented by surveys in particular groups of young people (homeless youth, young drug injectors) who may not be found in a typical household survey

The exact age groupings will vary according to the local situation. In countries where the mean age at first sex is in the early 20s, resources should be concentrated in the 20- to 24-year-old-group. Countries where a large proportion of the population is sexually active by age 15 may consider including 12- or 13-year-olds. A rise in age of sexual inception is an important response to HIV prevention messages, so it may be necessary to track behaviour in both teenagers and people in their early 20s. It is recommended that surveys be repeated in these groups every two to three years, with sample sizes between 400 and 500 in each age and sex group (males and females younger than 20, and 20 to 24 years).