Step 2: Identify sites where people meet new partners

Objective

To identify in each Priority Prevention Area (PPA) all public sites and events where people meet new sexual partners (and if appropriate, where injection drug users can be reached for intervention).

2.1 Overview of Step 2

The PLACE method recognizes the importance of new sexual partnerships in spreading the HIV/AIDS epidemic. The method focuses on new partnerships because individuals with high rates of new partner acquisition are more likely to transmit infection and because newly acquired infection is more infectious.

Because HIV/AIDS prevention programs cannot readily intervene in private settings, prevention programs focus on public sites where people meet new sexual partners.

HIV can also be transmitted through a network of injection drug users (IDUs) who share needles. Because injection drug use is illegal, IDUs often inject in private, making locations where the actual drug use occurs hard to access for prevention programs. Sites where IDUs socialize, rather than inject, provide a point of access to this population. Public sites offer HIV/AIDS prevention programs a strategic opportunity to reach local sexual or IDU networks that facilitate HIV transmission.

In Step 2, trained interviewers familiar with the PPA ask community informants to identify sites and events where people meet new sexual partners and, if appropriate, where IDUs socialize. This approach assumes that community members are knowledgeable about the movement and behavior of people in the area and that the informants will provide this information to interviewers.

2.2 Protocol Decisions

To ensure that the results of the PLACE assessment are directly useful to intervention groups, several protocol decisions are necessary to adapt the protocol to the local community. These decisions include determining the number and type of community informants to be interviewed to ensure that a sufficient number of viewpoints are obtained from all different types of people and developing probes that adequately solicit information about locations where populations of interest can be found.

1. Number and Type of Community Informant Interviews

A) How many community informants are interviewed?

The number of community informant interviews required to obtain an accurate and complete list of sites varies according to the size of the PPA, the type of sites in the PPA, and the characteristics of the PPA. Experience has shown that more sites are identified than usually anticipated. Table 2.1 shows the number of community informant interviews likely to be sufficient for obtaining a complete list of sites for PPAs ranging in size from an adult population of 20,000 to a population of 600,000 or more. The table also indicates the expected number of unique sites that will be named by the community informants. These numbers reflect the experience of 40 different implementations of the PLACE method.

Table 2.1 Recommended number of community informant interviews to be performed and expected number of unique sites that will be identified based on adult population size of PPA

B) Many types of community informants are located throughout the area. How many informants of each type should be interviewed?

After a list of the types of people likely to be knowledgeable about sites is developed, a target number for each type of informant is specified. Site types can include youth sites, sites where injection drug users socialize, clandestine sites, small sites, popular sites, sites where men who have sex with men meet partners, and sites where sex workers solicit clients. Bar managers, taxi drivers, police, security guards, cleaning women, street cleaners, market sellers, sex workers, patients at an STI clinic, health workers, truckers, college students, and street sellers have proven to be knowledgeable informants. Examples of the different types of community informants interviewed in previous PLACE studies are pictured in Figure 2.1.

Figure 2.1 Distribution of community informants from PLACE studies in a South African township (left) and in a Mexican border town (right)

2. Interviewer Probes

Interviewers ask community informants to name public sites where people meet new sexual partners, then probe for information about public sites and events where key populations of interest can be accessed by intervention groups. For example, depending on the local context, the interviewer might probe for public sites and events:

• inside the PPA where people meet new sexual partners;
• outside the PPA where people from the PPA meet new sexual partners;
• where key populations (e.g., sex workers, men who have sex with men, tourists, youth, mobile populations) meet new sexual partners; and
• where injection drug users can be reached (if appropriate)

2.3 Data Collection

Data collection begins with an in-depth interviewer training which provides an overview of the PLACE method and the goals of the current assessment, a discussion about ethics in human subject research and its application to the PLACE assessment, and instructions on interviewer methods and how to conduct community informant interviews. Interviewers are positioned throughout the PPA and assigned to complete a target number of interviews with a wide range of different types of community informants. After a brief interview to collect sociodemographic information about the community informant, the interviewer completes a site and event report form for every site or event named by the community informant. The Site and Event Report Form contains the name of the site, address, and how to locate the site so that the named sites can be visited in subsequent steps of the PLACE method. Fieldwork is carefully documented so that results can be interpreted based on the context of the current assessment and so that follow-up assessments in future years can replicate the process.

2.4 Getting Results

Data from the Site and Event Report Forms are compiled to create a complete list of all sites and events reported by community informants and the number of times that each site or event is mentioned. This list of events and sites where people meet new sexual partners (and, if appropriate, where IDUs socialize) is used as the basis for future field work to learn more about the people socializing at each site or event. Ultimately, a list of priority sites for intervention is developed and mapped.

Table 2.2 provides a summary of Step 2. It outlines the important activities necessary to complete this step.

Exercise

Exercise 4

Objective

To become familiar with the type of data collected from community members about where people meet new sexual partners and to use this data for simple informative analyses.

Instructions

In this exercise, you will use data about where people meet new sexual partners collected from community informants in Chackarona's Port City, the PPA chosen in Step 1. In Step 2, community members are interviewed about places where people meet new partners. A Community Informant Questionnaire is filled out for each person interviewed and a Site and Event Report Form is completed for each place that an interviewee names. If a community informant names 5 different places, 5 Site and Event Report Forms will be filled out for that person.

For this exercise, you will need to use two datasets. The "Informant" dataset you will use contains the information reported on each Community Informant Questionnaire. It has one row for every person interviewed as a community informant.

The second dataset you will use is called the "Site Report" dataset. This dataset was created using data from the Site and Event Report Forms. There is one Site and Event Report Form for each unique place listed by each community informant. Information from all of the Site and Event Report Forms was collapsed to create the "Site Report" dataset. Identical sites and sites that are reported with slightly different names or addresses but which are judged to be the same site are combined so that each unique site appears in only one row of the "Site Report" dataset. A site that was reported by 12 community informants is listed on 12 Site and Event Report Forms, but it appears only once in the "Site Report" dataset.

Events were not included in the implementation of PLACE in Port City, so they do not appear on the Site and Event Report Forms or in the dataset.

You may choose to view the datasets in Microsoft Excel or in HTML format if you do not have access to Microsoft Excel. You will need to refer to the Site and Event Form and Community Informant Questionnaire in order to interpret information presented in the datasets. If you need help in using Excel to answer the questions, instructions are provided here.

Forms

• Site and Event Report Form: [PDF]

• Community Informant Questionnaire: [PDF]

Data

• "Site Report" [MS Excel]

• "Informant" [MS Excel]

Use the "Informant" dataset to answer the following questions.

1. How many community informants were not willing to be interviewed? How many community informants were too young to be interviewed? How many community informants were both old enough to be interviewed and willing to be interviewed?

2. Make a table or pie-chart showing the distribution of the different types of community informants interviewed.

3. Which two types of community informants were interviewed most often in the Dock and Warehouse District? How many interviews were there with each of these two types of people in the Dock and Warehouse District?

4. What was the greatest number of places where people go to meet new sexual partners named by a single informant? What type of community informant named the greatest number of places?

Use the "Site Report" dataset to answer the following question.

1. How many unique sites were reported?

2. Which site was reported most often?

3. Make a table or pie-chart showing the distribution of the different types of sites reported. Each site should contribute only one number to the table or pie-chart.

4. Which three types of sites were reported most often? How often were these sites reported, and what percentage of the total sites fell into these three categories?

Answers

Exercise 4

1. How many community informants were not willing to be interviewed? How many community informants were too young to be interviewed? How many community informants were both old enough to be interviewed and willing to be interviewed?

   13 community informants were not willing to be interviewed. Three were too young. 246 community informants were successfully interviewed.

2. Make a table or pie-chart showing the distribution of the different types of community informants interviewed.

   Table 1: Distribution of the different types of community informants interviewed

   Type of Community Informant	Number of interviews	Percentage of interviews
   taxi driver	21	8.54
   dock worker	21	8.54
   bar, tavern, club worker/manager	17	6.91
   sailor	17	6.91
   unemployed	17	6.91
   other migrant or mobile worker	15	6.1
   beer/liquor store owner	15	6.1
   hawker/street vendor	13	5.28
   hotel or tourism worker/manager	13	5.28
   mechanic/petrol attendant	11	4.47
   security guard/cleaner	11	4.47
   teacher	10	4.07
   police/military officer	10	4.07
   hairdresser/barber	7	2.85
   sex worker	7	2.85
   youth out of school	7	2.85
   street person	7	2.85
   church worker	5	2.03
   truck driver	4	1.63
   health care worker	4	1.63
   port authority worker	4	1.63
   NGO staff	3	1.22
   youth in school	3	1.22
   beach boy/gigolo	2	0.81
   injection drug user	2	0.81
   Total	262	100.00

   
   Figure 1: Distribution of the different types of community informants interviewed

   

3. Which two types of community informants were interviewed most often in the Dock and Warehouse District? How many interviews were there with each of these two types of people in the Dock and Warehouse District?

   There were 8 sailors and 8 dockworkers interviewed in the Dock and Warehouse District. These two groups were interviewed more than any other type of community informant in the Dock and Warehouse District.

4. What was the greatest number of places where people meet new sexual partners named by a single informant? What type of community informant named the greatest number of places?

   A taxi driver named the greatest number of places where people go to meet new sexual partners; he named 10 sites within Port City.

5. How many unique sites were reported?

   142 unique sites were reported

6. Which site was reported most often?

   "Sheila", a store located in the Old Port area of Port City was reported 32 times, making it the site reported by the greatest number of community informants.

7. Make a table or pie-chart showing the distribution of the different types of sites reported. Each site should contribute only one number to the table or pie-chart.

Table 2: Distribution of the different types of sites reported by community informants for the 142 unique sites reported

Figure 2: Distribution of the different types of sites reported by community informants

1. Which three types of sites were reported most often? How often were these sites reported, and what percentage of the total sites fell into these three categories?

   Bars or taverns, nightclubs, and restaurants were the three types of sites reported most often. A total of 41 bars and taverns were reported (29% of all unique sites). A total of 21 nightclubs were reported (15% of all unique sites), and 19 restaurants were reported (13% of all unique sites). Together, these three site types accounted for over 57% of the total types of sites reported.