HIV behavioural surveillance surveys in conflict and post-conflict situations: a call for improvement

Behavioural surveillance surveys (BSSs), an evolution from the knowledge-attitudes-practice surveys (KAPs), are a tool to track trends in HIV/AIDS knowledge, attitudes and risk behaviour among populations. The data collected support organizations in targeting specific HIV/AIDS prevention and care activities, monitoring their effectiveness and coverage, and allocating scarce resources. The objectives are to evaluate the quality and standardization of BSS-like surveys undertaken in conflict and post-conflict situations, and to provide recommendations to humanitarian agencies and governments on how to improve their quality. Survey methodology was classified as reproducible if the population-based sampling defined a sampling frame using probabilistic sampling. Survey indicators were compared to internationally-accepted HIV indicators. The results showed that 14 (45.2%) of the 31 BSS-like surveys evaluated between 1998 and 2005 in 14 countries were classified as reproducible. Surveys undertaken by non-governmental organizations (NGOs) were significantly less reproducible than those undertaken by non-NGOs (p=0.05). The majority of surveys used at least one identical or similarly worded internationally-accepted HIV indicator for prevention and misperception but not for practice and attitudes. Few reported disaggregated indicators according to age or gender. It was concluded that the majority of BSS-like surveys are of insufficient methodological rigor to be reproducible. Few surveys reported internationally-accepted HIV indicators by gender and age which makes interpretability and comparison difficult. United Nations agencies, NGOs, and governments undertaking BSSs in conflict and post-conflict settings should proceed with a BSS survey once the design and plan for execution has been prepared by experienced and qualified experts. These experts should then oversee the survey, assure data quality and incorporate training of others in the process. A practical and field user-friendly BSS manual is needed for conflict affected and displaced population situations, one which is customized to take into account the special circumstances of such populations.