ABS Adult Behavior Survey 2008-2011

The introduction of antiretroviral (ARV) therapy for the treatment of HIV infection is essential if life expectancy and quality are to be improved for the millions of Africans living with HIV/AIDS. Little was known about the consequences of ARV introduction for sexual risk behavior and HIV transmission.

This application proposed a behavior survey to be included in the new Welcome Trust Programme grant to the Karonga Prevention Study. The full grant proposal was submitted to the NHSRC and considered on 24th March 2006. The committee requested that separate protocols be provided for each activity. Further to this, the Census Sero-survey protocol was submitted and at the time of this application it was awaiting consideration (application ?419: 'Impact of HIV in northern Malawi in the era of antiretroviral therapy: Census sero-survey).

The Census sero-survey covered the population of southern Karonga district (a continuation of the demographic surveillance system established during the five year programme prior to the time of this application). It consisted of a population based HIV sero-survey within a demographic surveillance system. The HIV sero-survey included an HIV survey with voluntary counselling and testing for HIV (VCT). This application describes an extra module for the survey, a behavior survey, which had fit into the overall Census Sero-survey as follows:

                                                         Census Sero-survey

Demographic Surveillance (Annual recensus and socio-economic update of whole population) :

• HIV Sero-survey (Eligible adults)
• Proposed behavior survey
• HIV survey (including VCT)

The HIV sero-survey was carried out in adults at baseline and after 4 years, with annual surveys in between for age groups at greatest risk. The proposed behavior survey was administered before the HIV survey and VCT, at each round.

Behavior data was intended to be used to measure changes in sexual behavior (especially risky sexual behavior), marital dynamics, behaviors such as condom use, and other determinants of HIV transmission such as partner concurrency and forced sex. This work provided useful information for national ARV delivery programmes, health education programmes, and HIV prevention programmes. Data on behavior change was also important in interpreting other research findings on the epidemiological and socio-demographic impacts of HIV.

                                                                 NHSRC Number: 419