Second generation surveillance for HIV aims to improve the validity and utility of routine serial HIV prevalence data. It includes the collection of data on sexual behaviour and sexually transmitted disease prevalence.
This paper reviews the function of sexual behaviour data in HIV surveillance and the methods used to determine which behaviours are monitored and how changes in behaviour can be assessed.
Sexual behaviour data provide a poor predictor of the future spread of HIV, but these data can provide corroboration of changes in HIV incidence and assist in attributing changes to particular aspects of risk. Significance tests should be used to assess changes in behaviour, but this requires transparent reporting of methods and sample sizes.
Collection of behavioural data will provide important retrospective information about the HIV epidemic progress and should not be neglected because of the focus on improving HIV sero-surveillance.
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"The study acknowledged that in some small countries such systems may be difficult to justify, and in others, MSM may be especially hard to recruit due to social, cultural or religious barriers. When sufficiently contextualised, regular and comparable behavioural surveillance can help to improve our understanding of trends in diseases and allow more precise planning and evaluation of prevention responses (Brown 2003; Garnett et al. 2006; McGarrigle et al. 2006). "
[Show abstract][Hide abstract] ABSTRACT: Community-based opportunistic self-completion surveying for sexual health programming is common among men-who-have-sex-with-men (MSM) in Europe, being used to generate evidence of unmet prevention need, for behavioural surveillance and as a platform for advocating HIV precautions. However, comparing survey findings across Europe is difficult because of varying measures and recruitment designs, and surveying has not occurred in all countries. EMIS (the European Men-who-have-sex-with-men Internet Survey) aimed to develop a pan-European Internet survey on HIV-related male homosexual behaviours and prevention needs both to increase research capacity and to move towards harmonisation of existing systems. Six associated partners (APs) recruited another 77 collaborating partners from academia, public health and civil society across 35 countries. Partners’ existing MSM surveys were collected and collated, producing a meta-survey which was discussed by all partners through rotating round-tables at a 2-day summit. Survey development continued iteratively through user piloting and partner feedback until the English language content was agreed. Transfer to an online survey application was followed by further testing before on-screen translation into 24 other languages, final testing and sign-off. The project’s visual identity and promotional materials were developed in close collaboration with national leads, tailoring products to match country specific needs while maintaining an overall project identity. Five international MSM dating websites were contracted to send carefully crafted instant messages to members in a series of waves. The survey sought common ground with stakeholders and respondents by endorsing ‘the best sex with the least harm’ for MSM. Real-time monitoring of responses allowed targeted spending of the advertising budget to maximise coverage and depth of responses. Fieldwork occurred during June–August 2010. Over 184,469 responses were submitted of which 94.4 % were eligible. Partners in 38 countries were supplied with a national database of 100 or more respondents for national analysis and outputs, while the AP team proceeded on international comparisons among 174,209 respondents in 38 countries. EMIS demonstrated the feasibility of multi-country community-based MSM Internet surveying with limited public funding. The concept of ‘the best sex with the least harm’ provided a common ground for a diverse range of stakeholders to collaborate. Meaningful involvement of a large number of collaborators in the survey design, its visual identity and in promotional strategies ensured unprecedented coverage and depth of recruitment. Flexible planning was essential and a patchwork of recruitment was required across a range of commercial and community partners. Careful design, piloting and presentation ensured the survey was acceptable and had both authority and perceived community benefit.
Sexuality Research and Social Policy: Journal of NSRC 05/2013; 10(4):243-257. DOI:10.1007/s13178-013-0119-4 · 0.87 Impact Factor
"This requires procedures to ensure a combined analysis of both behavioural surveillance (BS) data and data obtained from biological surveillance of HIV/AIDS and STI. BS allows for the monitoring of risks related to transmission of HIV and STI at the population level and provides a key source of information not only to understand the drivers of epidemics, but also for advocacy and for the planning and evaluation of prevention interventions [30,31]. The type of BS to be conducted, in particular the populations to be included in the surveillance, depends of the type of HIV epidemic (generalised, concentrated, low level) . "
[Show abstract][Hide abstract] ABSTRACT: Used in conjunction with biological surveillance, behavioural surveillance provides data allowing for a more precise definition of HIV/STI prevention strategies. In 2008, mapping of behavioural surveillance in EU/EFTA countries was performed on behalf of the European Centre for Disease prevention and Control.
Nine questionnaires were sent to all 31 member States and EEE/EFTA countries requesting data on the overall behavioural and second generation surveillance system and on surveillance in the general population, youth, men having sex with men (MSM), injecting drug users (IDU), sex workers (SW), migrants, people living with HIV/AIDS (PLWHA), and sexually transmitted infection (STI) clinics patients. Requested data included information on system organisation (e.g. sustainability, funding, institutionalisation), topics covered in surveys and main indicators.
Twenty-eight of the 31 countries contacted supplied data. Sixteen countries reported an established behavioural surveillance system, and 13 a second generation surveillance system (combination of biological surveillance of HIV/AIDS and STI with behavioural surveillance). There were wide differences as regards the year of survey initiation, number of populations surveyed, data collection methods used, organisation of surveillance and coordination with biological surveillance. The populations most regularly surveyed are the general population, youth, MSM and IDU. SW, patients of STI clinics and PLWHA are surveyed less regularly and in only a small number of countries, and few countries have undertaken behavioural surveys among migrant or ethnic minorities populations. In many cases, the identification of populations with risk behaviour and the selection of populations to be included in a BS system have not been formally conducted, or are incomplete. Topics most frequently covered are similar across countries, although many different indicators are used. In most countries, sustainability of surveillance systems is not assured.
Although many European countries have established behavioural surveillance systems, there is little harmonisation as regards the methods and indicators adopted. The main challenge now faced is to build and maintain organised and functional behavioural and second generation surveillance systems across Europe, to increase collaboration, to promote robust, sustainable and cost-effective data collection methods, and to harmonise indicators.
"Considerable funds, time, and energy are being spent purely on prediction, but unless our understanding of the system is sufficiently comprehensive, the models we build may be missing key structures or processes, and thus perform inadequately as a tool for developing effective interventions. Tracking pandemics is an extremely difficult task (García Calleja et al. 2005; Garnett et al. 2006; Ghys et al. 2006; Morgan et al. 2006; Walker et al. 2004), and as we will see below empirical data may be misleading if we do not interpret them carefully. We illustrate this point by presenting some of our recent research on controlling TB in areas of high HIV prevalence. "