After a much awaited wait, the TI Division and Technical Support Unit of KSACS has come out with a scientific solution for assessing behavioral impact of Suraksha Projects in condom usage and safe sex practices among FSWs and MSMs to reduce the risk of getting HIV and STI. Condom promotion is one of the core components of targeted interventions implemented under the National AIDS Control Programme, Phase -III (NACP-III). Since the beginning of 1997, Targeted Interventions in Kerala have been measuring the level of condom usage among the target group members through physical verification of number of condoms distributed or through irrational and unempirical methods like counting the number of used condoms in activity places, asking about condom usage during one-to-one/group interactions, etc.

Kerala State AIDS Control Society is implementing 53 Targeted interventions in the State through Non Governmental Organizations and stakeholder owned Community Based Organizations. Out of this, 19 interventions are exclusively working for female sex workers and 13 for MSMs. It is observed that all these projects are unskilled at assessing the behavioral impact caused by their interventions among the primary stakeholders. Periodical evidence-based empirical assessment of behavioral outcomes produced by the interventions is essential to revise the ongoing behavior change communication strategies. Accurate scientific assessment of condom usage and other service utilization by target group members is indispensable in behavioral outcome assessment.

Sexual health, particularly condom use is a very sensitive and personal issue that always creates a stumbling block before collecting genuine data to assess the impact of allied services implemented by the Suraksha Projects. The scope of “Polling Booth Surveys (PBS)” reclines here and hence the Technical Support Unit of KSACS (TSU of KSACS) suggests it as a solution to resolve this difficulty. Polling Booth Survey is a kind data collection methodology like group interview method, where respondents give their responses through a ballot box anonymously, and in an unlinked manner.

During the current phase of intervention, TSU has facilitated Polling Booth Surveys in the FSW/MSM projects with the purpose of evaluating the behavior patterns of MSMs and FSWs in Condom use, risky sexual activities and assess the utilization of services such as STI services, ICTC, etc. The information gathered from the Polling Booth Surveys can be used to monitor some of the behavioral outcomes of TI Programmes by understanding the level of condom use with different partners, STI/HIV Risk perception, high-risk sexual acts like anal sex and experience of violence by the members of high-risk groups.

For the well conduct of the Polling Booth Survey, TSU has developed separate questionnaires for MSMs and FSWs that contain systematically furnished scientific closed ended questions in the local language, covering areas like condom usage in last encounter with various partners (viz. paying clients, occasional clients, regular clients, lover, husband/co-habiting partner, etc.,), sex without condom, incidences of condom breakage, barriers in condom usage (Partner’s resistance, Influence of alcohol, Non-availability of condom, and covetousness for more money), risk perception, experience of violence and audit of services availed. The number of PBS in each district is determined proportionately based on the number of FSWs/MSMs line listed. One booth is arranged for the 20 samples selected from every 240 primary stakeholders. Systematic sampling method has been adopted to select the samples from the peer communication units. Stakeholder registration details available at the projects are used to select the required samples.

During the Survey, the selected respondents/samples are separated from each other in a polling booth environment created by sheets or cardboards. Each participant is given three glasses as ballot boxes specified with responses to the question like ‘YES, No, Not Applicable’ and a pack of cards stacked in serial order. The Cards are numbered corresponding to the number of questions in the questionnaire. The Facilitator explains the Polling Booth Survey method with an example and a practice session. She/he reads out the questions one by one, slowly and loudly in local language, so that every participant hears the question clearly. The participants answered each question by dropping the card carrying the question number into any of the three glasses. The card is kept outside the glasses, if the participant does not want to respond the question. After administering the questions, the answer cards are collected separately and the number of cards in each box for each question is counted and the tallies are recorded in the reporting form. The group responses are shared with the participants and the discussion points were documented.

The exercise is found to be excellent in assessing the behavioral outcomes of the targeted intervention initiatives implemented by the project. Since the process offers anonymity to the respondents, it reduces the social desirability bias. It is an efficient and easy tool to administer among both the literate and illiterate respondents by the project functionaries. It provides exact information on condom usage and risk behavior so as to equip the functionaries to analyze the outcome and impact of the intervention. KSACS/TSU is planning to use the method every year to analyze the impact of intervention and to make necessary strategy shifts in the behavior change communication process. It is certain that the process will improve the quality of Suraksha Projects in Kerala which in turn will support NACP to halt and reverse the epidemic by saturated coverage among core high risk groups.



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Comment by BPDU on August 13, 2010 at 1:11pm
Dear Gilliot,

Thank you for your comment. I could not access the internet due to technical reasons and hence I delayed in responding. Sorry for the same.
The exercise was beneficial in identifying the gaps and barriers in condom usage and safe sex practices among the core high risk group members. The information gathered through the exercise is helpful in enhancing the quality of targeted intervention programmes aimed to prevent HIV/AIDS among them. The staff members of TI Projects shared the analysis of the survey and generate discussions among the community members.
The methodology of the exercise was participatory and hence with the support of professional team available in the project, the community will be able to perform such evaluations again in the project.

Documentation Coordinator
Best Practice Documentation Unit of KSACS
Comment by Laurence Gilliot on August 9, 2010 at 10:19am
Dear George,

Thank you for sharing this experience. It is an interesting way to measure, in a scientific way, the impact of an intervention.

I have a few questions:
- How does this evaluation benefit the community? Are people informed about the results afterwards? Is there a discussion about the results?
- What does the community think about this intervention? Did they participate in organizing the evaluation? If they find it useful, can they organize this evaluation by themselves with support from KSACS?

How can we move from 'top-down' evaluations done by external actors to community-led evaluations where communities themselves measure their own progress? Because they want to know what the situation is. Because they want to do something about it. KSACS can play a role in facilitating local responses.

Best regards,



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