Issues in behavioural data collection – validity of self reported data on sexual behaviour:
Many questions were raised about the validity of self-reported data on sexual behaviour. Growing experience in collecting data on sexual behaviour indicates that the extent to which people answer questions openly and truthfully depends on factors such as the setting of the question, privacy and confidentiality, attitudes & profile of the interviewer, etc. While it was not possible to validate data on sexual practices by direct observation, it was possible to triangulate them with data from other sources to see if the picture presented was consistent and credible. Still, some misreporting of risk behaviour could occur and true levels of risk may either be under or over reported. However, for those tracking the HIV epidemic, the trends in risk behaviours is of greater concern than the exact level of risk behaviour at any given point of time. Even where there is misreporting, repeat behavioural surveys show changes in trends over time provided that the magnitude or direction of misreporting does not change significantly. To ensure maximum validity, the survey was implemented with high levels of quality control. This included intensive sensitisation and training of the interviewers, provision of a setting conducive to privacy, assuring and maintaining confidentiality so that the respondent could feel comfortable.
Survey Implementation
Qualitative exploratory research was first conducted to facilitate exposure to the target groups and to gain information that would contribute to the questionnaire development. The BSS questionnaires, based on those recommended by WHO/UNAIDS, were adapted for use in Gujarati and Hindi after doing intensive pre-testing. The implementation team was trained extensively in methods of data collection, basic facts of STIs and HIV/AIDS, sex and sexuality, socio-cultural issues related to working with high-risk groups and common problem situations in data collection along with approaches to manage them. This training was intended not only to enhance the quality of data collection but also to ensure consistent quality among the team members. A supervisory team had closely monitored the quality of data collection. Informed consent of all respondents was obtained before the questionnaires were administered either by an interviewer or in the case of students, through self-administration. The field work was done between October and November 1999. The data was analysed using SPSS.
Key findings
Key findings described briefly in this section mainly focus on demographic profile and knowledge and behaviour indicators in various sub-groups included in the study.
Female sex workers
Key demographics
The mean age of the female sex workers was 27.7 years. Forty four percent of the sex workers were illiterate (Figure. 1). Twenty percent of FSWs had reported having studied up to Class V and only 8% had stated that they were educated until Class X.
The marriage profile of the sex worker revealed a mixed picture. Thirty one percent FSWs had said that they were unmarried or had never married, 22% had indicated that they were married and 47% stated that they were either divorced/separated or widowed (Figure 2).
Behavioral indicators
Ninety six percent, 75%, 16% and 8% sex workers had reported having sexual intercourse with a one time client, regular client, spouse or cohabiting partner and non-paying partner respectively in the preceding month.
Condom use during last sexual intercourse and consistent condom use during the past year
The study indicated that the reported consistent condom use was lower than the reported condom use during the last sexual intercourse (Figure 3). Consistent condom use with one-time clients in preceding 12 months was reported to be 73%, which was lower than that with regular clients (78%).
The proportion of FSWs who had never used a condom in the preceding 12 months (4%) was lower with one-time clients than with regular clients (6%).
