HIV risk behavioral surveillance: a methodology for monitoring behavioral trends

AIDS. 1998;12 Suppl 2:S37-46.


Objective: This article summarizes issues and recommendations for conducting HIV risk behavioral surveillance surveys (BSS) based on experiences from ten BSS projects in eight countries in Asia and Africa.

Background: BSS consists of systematic and repeated cross-sectional surveys of HIV and sexually transmitted disease-related behaviors, with other knowledge and attitudinal variables added where appropriate. Its major purpose and utility is in detecting trends among selected vulnerable and high-risk population groups whose behavioral change can have the most impact on the epidemic. BSS is also useful for tracking trends in behaviors over time in regions exposed to HIV prevention activities, as a contributing component to the comprehensive monitoring and evaluation of interventions.

Recommendations: (i) implement BSS as an essential adjunct to HIV/STD epidemiological surveillance; (ii) use BSS for evaluation purposes in combination with process data and triangulate results with qualitative research; (iii) choose sentinel groups based on epidemiological considerations, evaluation and monitoring needs, representative sampling frames, and political and cultural considerations; (iv) maintain 1-year intervals between survey waves for most groups in order to provide yearly updates on behavioral trends for programmatic adjustments; (v) use internationally standardized indicators and question wording; (vi) maintain strict quality control standards to enhance data validity and reliability; and (vii) develop a clear dissemination strategy during BSS design to increase the likelihood of utilization of BSS results.

Conclusion: BSS represents a cost-effective way to determine whether programmatic behavioral targets and goals are being met, to identify persisting risk behaviors over time, and to indicate whether new intervention approaches are necessary.

PIP: Public health personnel have long monitored the distributions and trends of communicable and noninfectious diseases. Only recently, however, have efforts been made to monitor risk factors or behaviors which are themselves determinants of disease. Behavioral surveillance systems have been brought on line over the past 25 years to monitor risk factors such as cigarette smoking, drug and alcohol consumption, dietary factors, and physical exercise. The HIV risk behavioral surveillance survey (BSS) methodology is designed to systematically monitor trends in HIV risk behaviors over time in key, high-risk population sub-groups whose behavioral change can have the most impact upon the epidemic. BSS is conducted through repeated cross-sectional surveys conducted at regular intervals on a national or regional scale. BSS is also useful in tracking behavior trends over time in regions exposed to HIV prevention activities, as a contributing component to the comprehensive monitoring and evaluation of interventions. Recommendations for conducting BSS are drawn from the collective experiences of 10 BSS projects conducted in Thailand, the Philippines, Senegal, India, Indonesia, Cambodia, Hong Kong, and China between 1993 and 1997.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Africa / epidemiology
  • Asia / epidemiology
  • Cross-Sectional Studies
  • HIV Infections / epidemiology*
  • Humans
  • Population Dynamics
  • Population Surveillance*
  • Reproducibility of Results
  • Risk-Taking*