Summary Report: Behavioural Surveillance Survey in Gujarat, India: Part 6

Partners

The Department for International Development (DFID) of the UK government has been providing funds to the Gujarat State AIDS Control Society through the National AIDS Control Organisation for implementing targeted interventions among certain subpopulation groups at high-risk of HIV infection. These sub groups include, among others, commercial sex workers, men having sex with men, injecting drug users, truck drivers, migrant labour, slum dwellers, etc. The components of the HIV/AIDS prevention project in Gujarat include surveillance, condom promotion by ensuring that quality condoms are available and acceptable to those who are vulnerable to STIs and HIV, and to strengthen service providers to respond to the needs of the high-risk groups that are reached through targeted interventions.

Strategies adopted for reducing risks of the populations reached through targeted interventions include behaviour change communication mainly through the peer educators, provision of STI treatment services, condom promotion and counselling where necessary. GSACS had contracted several NGOs to work with the target groups. This was mainly because NGOs were able to develop a better rapport and gain the trust of high-risk groups.

Behaviour surveillance surveys (BSS)

The BSS is a monitoring and evaluation tool designed to track trends in HIV/AIDS related knowledge, attitudes and behaviours in sub-populations at particular risk of HIV infection. The BSS findings provide indicators of success or failure of prevention activities, highlight persistent problem areas, identify appropriate intervention target populations, identify specific behaviours in need of change, function as a policy and advocacy tool and supply comparative data concerning behavioural risks.

Objective

The objective of the BSS in Gujarat was to measure HIV-related risk behaviours in selected population sub-groups. The measurements presented in this report serve as a baseline from which to measure trends in the future.

Methodology Indicators

Behavioural surveillance consists of repeated cross-sectional surveys in selected population groups which provide measurements on certain indicators. In the baseline wave in Gujarat, data were collected on two main indicators: (a) behaviour indicators and (b) knowledge indicators. The list of indicators is included in the Annex.

The measurements of these indicators provide proportions reporting a particular behaviour or knowledge.

Study population

In Gujarat, the subpopulations surveyed included those with known high-risk behaviours and others with varying estimates of risk behaviours. Representatives from GSACS, Project Support Unit (PSU), Ahmedabad, Project Co-ordination Office (PCO), Surat, Ahmedabad Municipal Corporation AIDS Control Society, DFID and other local experts gathered together to list out possible groups for inclusion in the survey. Available research findings, anecdotal evidence and reports from NGOs were the basis from which information on risk behaviour was taken. The groups, presented in Table 1, were finally chosen for the survey from the list of suggested groups.

Table 1: Sub populations surveyed in the Gujarat BSS

The expert group that had met to decide on the sub population groups for the Gujarat BSS had also listed out the locations where these groups were found in the state. Places with highest concentration of these groups were chosen based on the information available on the short-listed locations. Table 2 lists the sites where the study was conducted.

Table 2: BSS sites and sample sizes

Sampling design and sample sizes

The sampling frame was constructed in two ways — with the assistance of NGOs working with the specific sub populations and through mapping exercises. A two stage sampling procedure was used to select respondents. The clusters were selected using either probability proportional to size (PPS) or equal probability (EP) in the first stage of sampling and the respondents were randomly selected in the second stage.

The sample sizes were chosen based on the measurement of change on a given indicator. This was based on various factors such as the estimated baseline level of the indicator, a magnitude of change (15%) that can be detected reliably, using a desired level of significance and power as well as the percent of the population that is eligible to be considered for the indicator.