Summary Report: Behavioural Surveillance Survey in Gujarat, India: Part 4

Executive summary

This report is a summary of the methodology and findings of the Gujarat HIV Risk Behavioural Surveillance Survey (BSS). This survey, which was a part of the impact assessment of HIV prevention activities in Gujarat, was conducted in late 1999, for the Gujarat State AIDS Control Society (GSACS). The technical assistance from provided by the Family Health International (FHI) and funding was from Department for International Development (DFID). ORG Centre for Social Research, a division of ORG-MARG Research Limited had implemented the survey.

This BSS was intended to serve as a baseline from which future trends in HIV/AIDS related knowledge, attitudes and behaviours could be measured in the sub-populations of Gujarat at particular risk of HIV infection. It was also meant to contribute to the larger monitoring and evaluation efforts of the GSACS. The two core indicators on which data was collected included behaviour indicators and knowledge indicators.

Secondary indicators provided information on incidence of STI symptoms, treatment-seeking behaviour, messages recalled on HIV and sources of HIV related information, practices related to condom use etc. All the indicators were based on those recommended by WHO/UNAIDS for national AIDS programmes.

Sampling

The study sample was drawn from sub population groups that ranged from those with known high-risk behaviour such as female sex workers (FSW) and male clients of female sex workers (MC) to others who had varied estimated high-risk behaviours like sexual intercourse with a non-regular partner. Representatives from GSACS, Project Support Unit (PSU), Ahmedabad, Project Coordination Office (PCO), Surat, Ahmedabad

Municipal Corporation AIDS Control Society, DFID representatives and other local experts had together prepared a list of possible groups that could be included in the survey. Information on the risk behaviour was taken from available research findings, anecdotal information and reports from NGOs working with high-risk groups. Based on this information, the study groups were finally chosen. The sub populations sampled included male slum dwellers (MSD), male diamond industry workers (MDIW), female slum dwellers (FSD) and male university students (MUS).

The BSS sampling universe consisted of areas in the state where major concentrations of the above groups were located. The seven places where the survey was implemented covered cities as well as purposefully selected districts. The sample sizes were chosen based on the estimated level of key risk behaviours and the degree of confidence (95%) required to detect a significant change (15%) in behaviour over time.

The sampling frame was constructed with the assistance of those working with the specific sub populations as well as mapping exercises. A two stage systematic random sampling procedure was used to select respondents. Clusters were selected in the first stage of sampling and the respondents were selected randomly in the second stage. Depending on the nature of the group, the clusters were selected with either probability proportional to size (PPS) or equal probability (EP).

Implementation

Qualitative exploratory research was first conducted to facilitate exposure to the target groups and to gain information that would contribute to development of the questionnaire. The standardised BSS questionnaires were adapted for use in Gujarati and Hindi after intensive pre-testing. The implementation team had received training in, among other topics, methods of data collection, HIV/AIDS, sex and sexuality and socio-cultural sensitivities related to working with high-risk groups. PSU and many NGO partners, especially Jyoti Sangh and SAHAS from the PSH project had assisted ORG to understand the socio dynamics of the sex industry and also in the designing and implementing training of field workers. A supervisory team had closely monitored the quality of data collection. The data was analysed using SPSS. The questionnaires were administered either by an interviewer or through self-administration as in the case of students after informed consent was obtained.