Indicator 8.1: "Higher risk sex in the last year"

Definition

The percent of respondents who have had sex with a non-marital, non-cohabiting partner in the last 12 months of all respondents reporting sexual activity in the last 12 months

Measurement Tools

UNAIDS general population survey; DHS AIDS Module; FHI BSS

What It Measures

The spread of HIV depends upon unprotected sex with people who also have other partners. Most monogamous relationships are cohabiting, although the reverse is not necessarily true. Partners who do not live together--who have sex only occasionally--are those who are most likely to have other partners over the course of a year. These partnerships therefore carry a higher risk of HIV transmission than partnerships that do not link into a wider sexual network. AIDS prevention programmes try to discourage high numbers of partnerships, and to encourage mutual monogamy. This indicator aims to give a picture of the proportion of the population that engages in relatively high-risk partnerships and that is therefore more likely to be exposed to sexual networks within which HIV can circulate.

How to Measure It

Respondents are asked about their marital status and the last three sexual partners within the last 12 months. For each partner, details are taken of cohabiting status as well as duration of the relationship, condom use and other factors. The numerator is those respondents who say they have had sex with someone who is not their spouse or the person they live with in the last 12 months. The denominator for this indicator is all respondents who report having any sex in the last 12 months.

Respondents are asked about their marital status and the last three sexual partners within the last 12 months. For each partner, details are taken of cohabiting status as well as duration of the relationship, condom use and other factors. The numerator is those respondents who say they have had sex with someone who is not their spouse or the person they live with in the last 12 months. The denominator for this indicator is all respondents who report having any sex in the last 12 months.

Polygynous men who live with several spouses will not qualify for the numerator unless they also have sex with women who are not part of their household.

Strengths and Limitations

This indicator gives a picture of levels of non-monogamous sex. If people stop having sex with all of their extramarital partners, the change will be captured by changes in this indicator. However, if people simply decrease from seven extra-marital partners to one, for example, the indicator will not reflect a change, even though potentially this may have a significant impact on the epidemic spread of HIV and may be counted a programme success.

This indicator proposes a different definition for higher-risk sex than that commonly used in the past, particularly in the calculation of WHO/GPA Prevention Indicator 4 (PI4). PI4 used the time-based definition of regular and non-regular described above. Obviously, a change in definition will upset trend data for countries that have collected data on PI4 using that definition. However, this difficulty is not insurmountable. The proposed data collection instrument allows for both the old PI4 and Sexual Behaviour Indicator 1 to be calculated simultaneously. In practice, in existing data which allow for the comparison between the two indicators, the difference has been small. The change is proposed largely because countries report dissatisfaction with PI4, arising mostly from respondents' difficulties in understanding the definitions of regular and non-regular partnerships.