Behavioural Surveillance Surveys: Exploring Epidemic Dynamics, Measuring Progress

Family Health International (FHI) India

Behavioural Surveillance Surveys (BSS) are increasingly being added to HIV surveillance systems to measure behaviour among groups considered vulnerable to HIV infection. These surveys are being used in a range of ways: to identify behavioural risk practices; links between population groups with high risk behaviours and general population; intersections of high risk behaviours; tracking the potential for spread between high and low prevalence epidemics; providing evidence of success of interventions and greater in-depth understanding of the epidemic. FHI has collected results of BSS from a number of countries and reports from Vietnam, India, Laos, Nepal and Bangladesh were presented. BSS are providing useful information on estimates of magnitude of the epidemic, specific information on risk behaviours, particularly in areas of commercial sex work and injecting drug use. BSS are also identifying extent of reach of these behaviours in cities and states. One of the findings of recent BSS work is the overlap between people with risk behaviours, particularly between injecting drug users and sex workers. While BSS is useful to identify trends and patterns, it does not readily identify behavioural dynamics within population groups. BSS data can be enhanced by qualitative methods that solicit further information on particular contexts in which risk behaviour occurs, factors affecting behaviour and meanings of risk. When this information is combined with BSS data it provides a better basis for the development of interventions. Another important use of BSS is for the evaluation of prevention programs. Simply constructed surveys using exposure to intervention variables and measures of safer sex can show whether interventions have had an impact on behaviour. Similarly when BSS is combined with biological surveillance systems, this can provide evidence of success of prevention programs.There is great potential for BSS to be used for program evaluation however these areas could not be explored during this session. To support this session, FHI distributed a useful booklet on BSS results from a number of Asian countries: What drives HIV in Asia? A Summary of Trends in Sexual and Drug-Taking Behaviours.