Throughout Bangkok, in offices, factories, gas stations, brothels, schools and households, people are talking about sex. Periodic interviews conducted at strategic sites throughout the city are yielding a wealth of information about sexual behavior for HIV/AIDS prevention program managers and evaluators. These interviews are part of the behavioral surveillance survey (BSS) developed by the AIDS Control and Prevention (AIDSCAP) Project.
Modeled after the serological surveillance used in many countries to detect the emergence of HIV and monitor epidemic trends, the BSS involves administering structured questionnaires to sample groups of target populations in specific geographic areas. The survey is designed to collect detailed information about the sexual behaviors that increase or reduce people's risk of HIV infection and provide indicators that can be tracked over time.
In Bangkok, the BSS is part of the Bangkok Fights AIDS (BFA) Project funded in part by AIDSCAP and coordinated through the Bangkok Metropolitan Administration (BMA). Interviews with more than 3,000 people are conducted every six months among the six groups targeted by the program.
A typical interview in Bangkok lasts no longer than 30 minutes. Interviewers found that it took about 15 minutes to build sufficient trust and rapport for respondents to reveal intimate information about their sex lives. After conducting initial qualitative research, the project team decided to have women respondents write the answers to more sensitive questions on a self-administered questionnaire.
Like epidemiological surveillance, BSS can serve as an early warning system, alerting policy makers and program managers to increases in risk behavior. It can also help guide prevention programs by identifying groups whose behavior makes them particularly vulnerable to HIV infection and specific behaviors that need to be changed. In Bangkok, for example, data from the BSS convinced project managers of the need to direct prevention interventions to single, sexually active women who are not commercial sex workers.
For evaluation, BSS provides a baseline for measuring the impact of prevention efforts and a series of cross-sectional "snapshots" of behavioral trends among vulnerable groups. This kind of "big picture" is more useful to policy makers and program managers than the results of small KABP (knowledge, attitudes, beliefs and practices) studies, noted Stephen Mills, evaluation officer and epidemiologist in AIDSCAP's Asia Regional Office in Bangkok.
Even though AIDSCAP's Thailand program will end in September 1996, the BSS will continue to help guide and evaluate HIV/AIDS prevention in Bangkok. At the request of the BMA, AIDSCAP's regional office recently held a workshop on behavioral surveillance for BMA staff.
The success of BSS in Bangkok has generated interest throughout Thailand and in other countries. The Thai Ministry of Health has begun behavioral surveillance modeled after the BSS in most of the country's provinces. AIDSCAP is starting the first round of behavioral surveys for the HIV/AIDS Prevention Project (HAPP) in Indonesia and is providing technical assistance in behavioral surveillance to the AIDS Prevention and Control (APAC) Project in Tamil Nadu, India. In Africa, AIDSCAP is applying the BSS methodology in Senegal.
Why all this interest in behavioral surveillance? Mills believes the BSS fills two gaps in evaluation information: what is the short-term effect of prevention interventions and what are the trends in risk behaviors among vulnerable groups? "Even though we can't pick apart the impact of different interventions, we are interested in whether the combined interventions are working together to change risk behaviors," he added. "In Bangkok, we can say that behaviors are changing."
-- Kathleen Henry
