Step 3: Site Verification Interviews

Objective

To verify the existence of the sites and events identified by community informants, collect information on site characteristics that are important for planning targeted HIV/AIDS prevention activities, and map the location of each site.

3.1 Overview of Step 3

Step 3 is the heart of the PLACE method. In Step 1, the geographic boundaries of the Priority Prevention Areas (PPA) are defined. In Step 2, community informants in the PPA report the names of sites where they believe people meet new sexual partners or where injection drug users socialize. In Step 3, interviewers attempt to locate each reported site, document the existence and location of the site, and interview someone knowledgeable at the site about the characteristics of the site and its patrons.

Important assumptions include the following:

1. That site representatives are willing to report information about socially unacceptable or illegal behaviors that occur at the site such as people meeting new sexual partners, commercial sex workers soliciting clients, or injection drug users socializing at their sites;

2. That site representatives are knowledgeable about characteristics of individuals who patronize the sites; and

3. That self-presentation bias is reduced by not asking questions about personal behavior of the site representative.

The information collected through site verification interviews is necessary to describe sites where HIV transmission is likely to occur and to develop a list of priority sites for prevention programs. Global positioning system (GPS) coordinates of each site are also obtained so that the geographic distribution of sites within the PPA can be displayed visually on a map.

The PLACE method focuses on describing and mapping sites where people meet new sexual partners (and if appropriate, where injection drug users socialize) for the following reasons:

• Data showing the number and diversity of sites where people meet new sexual partners (and injection drug users socialize) serves as a useful gauge of the local potential for HIV/AIDS transmission. In every application of the method, many unknown venues have been revealed. Frequently, more sites are identified than anticipated. The number and diversity in the types of sites and their patrons often exposes patterns of transmission opportunity that were previously unknown. For example, in several PLACE assessments, sites where youth meet new sexual partners have included fast-food restaurants, video shops, and malls. The variety and sheer number of sites often serves as a dramatic reminder to prevention programs that the scope and size of the sexual network in their communities can easily serve as the mechanism for widespread HIV/AIDS transmission.

• PLACE uses a site-based approach rather than a risk group-based approach to prevention. Rather than targeting risk groups directly, PLACE identifies sites where these individuals can be reached by site-based intervention programs. Site-base prevention programs are advantageous because they potentially reach many different risk groups socializing at a single site and thus prevent transmission through multiple routes and in several key populations.

3.2 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 protocol decisions include determining which sites to verify, and how to classify sites that fall into multiple site type codes.

1. Inclusion criteria for site mapping and characterization

Sites located outside the PPA, but near the boundaries of the PPA, may play an important role in the network structure present in the specified PPA. Sexual networks are not constrained by administrative boundaries. To obtain the most complete picture of the underlying network, all sites named by community informants located inside or in the area contiguous to the PPA are verified.

If it is not feasible to verify all sites named by community informants due to time or budget constraints, sites outside the PPA, particularly those located outside the immediate vicinity, or sites that are not accessible to intervention programs can be excluded from site verification. Excluding sites from the site verification phase could obscure the underlying sexual network, making it difficult to visualize the complete picture of the interconnectedness of sites. However, sites that are located far away are less likely to play an integral role in the underlying sexual network.

If the number of sites to be verified after exclusion criteria has been applied still exceeds time and budget constraints, a random sample of sites eligible for verification can be selected. Alternatively, the boundaries of the PPA can be reduced so that the number of sites located inside the PPA is smaller.

During site verification interviews, site representatives are asked to name other sites where their patrons meet new sexual partners. Many of these sites will already have been named by community informants, although a few will not have been. If time and resources allow, these new sites are verified to give a more complete picture of the network of sites where people meet new sexual partners. While community informant interviews produce a comprehensive list of sites, it is recognized that a few sites will be missed. Site representatives have a slightly different perspective that could potentially yield a few additional sites not identified by community informants. Inclusion of these additional sites ensures that few sites are missed.

2. Characterization of outdoor and multi-use sites

Outdoor places or areas without walls (such as streets or street corners) are often named as sites. Locally appropriate methods are used to define these sites. To obtain correct information, the interviewer must fully understand the definition of a site without walls and be able to explain it accurately to the respondent.

Sites with characteristics of more than one type are coded as the type that most closely identifies how the site is operating at times when high-risk activities occur, such as people meeting new sexual partners or sex workers soliciting clients. This classification ensures that appropriate interventions are designed for the site and its patrons. For example, if a site is a restaurant during the day but operates as a nightclub at night, then the site should be coded as a nightclub, since it is during the evening and nighttime hours when the high risk behaviors are reported to occur.

3.3 Data Collection

1. Interviewer Training

Prior to the beginning of site verification, interviewers receive training which includes a discussion of the rationale, objectives, and methods for site verification interviews. In addition, results of the community informant site reports are presented and discussed. These results include the number of people interviewed, the total number of site reports, and number of unique sites. Interviewers are also asked to comment on the strengths and weaknesses of the method, community acceptance of the assessment, and any suggestions for future improvements.

2. Fieldwork

Site verification takes place no more than one week after community informant interviews. The field coordinator assigns each pair of interviewers a list of sites to verify. Verification means locating a site and confirming that it is a place where people meet new sexual partners. Additional information is also obtained, such as the types of people who visit the site, the number of people at the site at a busy time, and whether HIV/AIDS information and condoms are available at the site.

Each pair of interviewers visits the sites that they are assigned and identifies a person knowledgeable about the site and requests an interview. The knowledgeable person at the site may be the manager or owner of the site. At places like taxi stands, street corners, or parks, there may not be a person in a position of leadership. In such cases, the interviewers choose a person who is likely to be familiar with the site. For example, a food vendor who regularly sets up shop near a city park could be approached for an interview. This person is not in a position of responsibility for the park, but is likely to know about the types of people that visit there. If the site cannot be found or is closed, the interviewers ask people in the area where the site is located and the days and times that it is open. If no one is available for an interview during the first visit, the site is re-visited.

Documentation of fieldwork is important to ensure that a complete record of what was done is kept 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.

3. Mapping

Mapping sites is an important component of the PLACE protocol. Mapping can be done at any point after the final list of verified sites is obtained.

Measuring site coordinates with a global positioning system (GPS) unit is the preferred method for identifying sites on a base map since it provides accurate information about location and distance from other sites or landmarks. To enhance the utility of the maps, landmarks such as schools, taxi stands and bus terminals, churches, police stations, health clinics and others are also mapped with a GPS unit.

3.4 Getting Results

1. The consolidated site list produced by community informant interviews in Step 2 is updated with new information. Corrected site names and address obtained during site verification interviews are added, and the list is scanned for additional duplicates and consolidated accordingly. Sites that were not found are excluded. New information about sites that was collected during Step 3 is added, including the number of men and women socializing at the site at a busy time and a code representing the total number of people socializing at the site at a busy time.

2. The next step is to determine the gender distribution of interviews to be performed. This is based on the total ratio of men and women socializing at all sites. The product of Step 3 is a final site list that will be used to select sites where socializing individuals will be interviewed in Step 4, sampled with a male to female ratio at each site that is the same as the male to female ratio of the overall sample.

3. Tables summarizing fieldwork and site characteristics are produced. These tables include the following information about each site:

   • Current HIV/AIDS prevention programs, willingness to host future prevention programs, and condom availability;

   • Site characteristics such as the number of workers, length of time the site has been in operation, busy times, and activities occurring on site such as alcohol consumption, videos, sex worker solicitation

     

      For more information, please see resources 7,8, and 10.

     

      For more information, please see resources 7,8, and 10.

     
     

      

   • Patron characteristics, such as the estimated proportion of patrons at the sites who are students, who live within walking distance of the site, who drink alcohol at the site, who meet a sexual partner at the site, etc.

     
     

      For more information, please see resource 17.

4. Maps showing the geographic distribution of sites and key site level characteristics, such as condom availability, are produced.

   One of the most useful maps for an intervention team is one indicating condom availability at sites (Figure 3.1).

   Figure 3.1. Example of a map showing condom availability at sites

   

   Another option for showing program coverage with maps is to illustrate which sites had any prevention activities (Figure 3.2). Different types of interventions can be marked with different symbols or colors.

   Figure 3.2. Example of a map showing at which sites in a district HIV/AIDS prevention activities had ever taken place

   

Summary of site verification protocol

Table 3.1 provides a summary of Step 3. It outlines the important activities necessary to complete this step. Further information about each activity is provided above.

Table 3.1. Summary of site verification protocol

Exercises

Exercise 5

Objective

To become familiar with the type of data collected during site verification and to use this data for informative analyses about the characteristics of sites and their patrons.

Instructions

In this exercise, you will use data collected from interviews at the sites where people meet new sexual partners listed by community informants in Step 2. In Step 3, interviewers attempt to locate each of these reported sites, document the existence and location of each site, and interview a knowledgeable person found at each site about characteristics of the site and its patrons. This information is collected for each site using a Site Verification Form.

For this exercise, you will need to use the Site Verification dataset. This dataset is created from information collected using the Site Verification Form. There is one row in the dataset for every site visited. Both the Site Verification Form and Site Verification dataset are provided for you, below. You may choose to use the Site Verification dataset in Microsoft Excel. If you do not have access to Microsoft Excel, you can also view the dataset in HTML format in order to complete the first part of this exercise.

Form

• Site Verification Form: [PDF]

Data

• Site Verification Data: [MS Excel]

If you need help in using Excel to answer the questions, instructions are provided here.

1. How many sites in the Priority Prevention Area (PPA) did interviewers attempt to visit?

2. In how many sites in the PPA were interviews successfully conducted?

3. How many sites were visited where no interview was conducted? Why was an interview not conducted at these sites?

4. According to the site representatives interviewed at each site, how many sites were places where men meet new sexual partners? How many sites were places where women meet new sexual partners?

5. At what types of sites was an interview not successfully conducted?

6. Out of the total number of unique sites visited, what was the most common type of site? The least common? (To answer this question, only look at sites where an interview was successfully conducted, where there was no willing respondent, or where all potential respondents were too young. Exclude sites that were closed temporarily or permanently, sites that could not be found, and duplicate sites.)

For questions 7-17, only use information from sites where an interview was successfully conducted. That is, exclude sites where there was no willing respondent, sites where all potential respondents were too young, sites that were temporarily or permanently closed, duplicate sites, and sites that could not be found.

1. At what percent of all sites were sex workers reported to solicit clients?

2. At what percent of all sites were females aged 15 to 19 reported to socialize? At what percent of all sites were males aged 15 to 19 reported to socialize? At what percent of all sites were youth aged 15 to 19 of either gender reported to socialize? For this question, you will need to count sites where youth aged 15-19 are described as being either "some" or "most" of the people socializing to get the total number of sites where youth aged 15-19 socialize. To answer the question for youth of either gender, you will need to include sites where some or most of the patrons socializing are either males or females aged 15-19.

3. At what percent of all sites were condoms never available in the past year?

4. At what percent of all sites were condoms available and seen by the interviewer during the site verification visit?

5. At what percent of all sites was the respondent willing to have an onsite AIDS prevention program?

6. What percent of all sites had more than 100 people socializing at a busy time?

7. At what percent of all sites is beer or alcohol available?

8. What is the total number of people socializing at all sites at a busy time? Why is this number important?

9. What percent of all sites had both youth aged 15-19 socializing and sex workers soliciting clients?

10. At what percent of all sites were there sex workers soliciting clients and no condoms which could be seen by the interviewer?

11. What percent of all sites had alcohol available, youth aged 15 to 19 socializing, and no condoms which could be seen by the interviewer?

Answers

Exercise 5

1. How many sites in the Priority Prevention Area (PPA) did interviewers attempt to visit?

   Interviewers attempted to visit 142 sites in the Port City PPA.

2. In how many sites in the PPA were interviews successfully conducted?

   Interviews were successfully conducted in 128 sites.

3. How many sites were visited where no interview was conducted? Why was an interview not conducted at these sites?

   There were 14 sites visited where no interview was conducted.

   At 8 sites, there was no person who was willing to respond to the interviewer's questions.

   At one site, there were no potential respondents who were old enough to be interviewed (at least 18 years of age).

   One site was a duplicate site that had already been identified. The site identified as "White House" at 34 North Penn Street turned out to be the same site as "XYZ Supplies", also at 34 North Penn Street.

   Lastly, one site was temporarily closed, two sites were permanently closed or were no longer sites, and one site could not be found.

4. According to the site representatives interviewed at each site, how many sites were places where men meet new sexual partners? How many sites were places where women meet new sexual partners?

   71 out of the 128 sites where a representative was interviewed were reported to be places where women meet new male sexual partners.

   71 out of the 128 sites where a representative was interviewed were reported to be places where men meet new female sexual partners. Interestingly, some sites where women were reported to meet new male sexual partners were not reported to be sites where men meet new female sexual partners. At 4 of the 71 sites where men meet new female partners, men were reported to meet new male sexual partners as well.

5. At what types of sites was an interview not successfully conducted?

   The types of sites where some interviews were not successfully conducted included formal bars and taverns, nightclubs, a gay bar, adult clubs and shops, a place offering overnight accommodation, restaurants, and stores.

6. Out of the total number of unique sites visited, what was the most common type of site? The least common? (To answer this question, only look at sites where an interview was successfully conducted, where there was no willing respondent, or where all potential respondents were too young. Exclude sites that were closed temporarily or permanently, sites that could not be found, and duplicate sites.)

   The most common type of site was a bar or tavern; 39 bars or taverns were visited during site verification. No informal bars were identified as sites. The least common types of sites were hidden, private, or abandoned dwellings. In this category, only one unused house was located during site verification. No private dwellings, abandoned yards, public toilets, or other private or hidden places were identified as sites. There were also few transportation, public, or commercial areas identified as sites. No truck stops, taxi stands, general port areas, convenience stores, liquor stores, construction sites, or craft markets were identified, and only one bus stop, market, high school, mall, and water theme parks were verified.

7. At what percent of all sites were sex workers reported to solicit clients?

   Sex workers were reported to solicit clients at 60 out of the 128 sites (46.9 percent).

8. At what percent of all sites were females aged 15 to 19 reported to socialize? At what percent of all sites were males aged 15 to 19 reported to socialize? At what percent of all sites were youth aged 15 to 19 of either gender reported to socialize?

   Females aged 15 to 19 were reported to socialize at 57 out of the 128 sites (44.5 percent).

   Males aged 15 to 19 were reported to socialize at 67 out of the 128 sites (52.3 percent).

   Youth of either gender aged 15 to 19 were reported to socialize at 94 out of the 128 sites (73.4 percent).

9. At what percent of all sites were condoms never available in the past year?

   Condoms were never available in the past year at 76 out of the 128 sites (59.4 percent).

   

10. At what percent of all sites were condoms available and seen by the interviewer during the site verification visit?

    Condoms were available and seen by the interviewer during the site verification visit at 16 out of the 128 sites (12.5 percent).

11. At what percent of all sites was the respondent willing to have an onsite AIDS prevention program?

    82 out of the 128 sites (64.1 percent) were willing to have an onsite AIDS prevention program.

12. What percent of all sites had more than 100 people socializing at a busy time?

    28 out of the 128 sites (21.9 percent) had more than 100 people socializing at a busy time.

13. At what percent of all sites is beer or alcohol available?

    Beer or alcohol is available at 119 out of the 128 sites (93.0 percent).

14. What is the total number of people socializing at all sites at a busy time? Why is this number important?

    A total of 11,321 people were reported to be socializing at all sites at a busy time. This number is important because it represents the total population of people socializing at sites identified by the PLACE method. It represents the number of people socializing at a busy time who could be reached by a site based intervention introduced at PLACE venues. A sample of the individuals socializing at sites will be interviewed in the next step of the PLACE method.

15. What percent of all sites had both youth aged 15-19 socializing and sex workers soliciting clients?

    46 out of the 128 sites (35.9 percent) had youth aged 15-19 socializing and sex workers soliciting clients.

    Sex workers soliciting clients?
    Yes	No
    Youth aged 15-19 at site?	Yes	46	48	94
    	No	14	20	34
    60	68	128

16. At what percent of all sites were there sex workers soliciting clients and no condoms which could be seen by the interviewer?

    At 49 out of the 128 sites (38.3 percent) there were sex workers soliciting clients and no condoms which could be seen by the interviewer.

    Sex workers soliciting clients?
    Yes	No
    Was a condom seen by the interviewer?	Yes	11	5	16
    	No	49	63	112
    60	68	128

17. What percent of all sites had alcohol available, youth aged 15 to 19 socializing, and no condoms which could be seen by the interviewer?

    At 75 out of the 128 sites (58.6 percent), alcohol was available, youth aged 15 to 19 were socializing, and no condoms could be seen by the interviewer.

    Alcohol Available?
    Yes			No
    Was a condom seen by the interviewer?			Was a condom seen by the interviewer?
    Yes	No	Yes	No
    Youth aged 15-19 at site?	Yes	12	75	87	0	7	7
    	No	4	28	32	0	2	2
    16	103	119	0	9	9

Back to the PLACE Course Home