Step 4: Describe Site Patrons

Objective

To describe the sociodemographic characteristics, sexual and, if appropriate, drug use behaviors, and exposure to HIV/AIDS prevention programs of individuals socializing at sites identified in previous steps of the PLACE method in order to confirm whether interventions introduced at these sites will reach people with a high rate of new partner acquisition and/or people who inject drugs.

4.1 Overview of Step 4

The PLACE method was developed based on epidemiological models of the HIV/AIDS epidemic. These models indicate that a complex set of biological and behavioral factors at the individual and population levels determine the HIV epidemic within a given community. Among the most important factors at the population-level are the rates and pattern of new sexual partnership formation and injection drug use. Important questions include the following:

• What proportion of the population had a new sexual partner during the past month and past year?
• To what extent do people form new sexual partnerships with residents of their community, with visitors to the community, and with both mobile and resident populations?
• What proportion of new partnerships are characterized by commercial sex?
• To what extent do people with many new partners remain in contact with previous sexual partners?
• What proportion of the population injects drugs?
• To what extent do injection drug users share needles?

Step 4 focuses on people socializing at the sites named and characterized during earlier steps of the protocol as places where people meet new sexual partners and/or injection drug users socialize. Characteristics of the people who socialize at these sites are obtained to confirm whether interventions at these sites will reach people with a high rate of new partner acquisition and/or people who inject drugs. This step is the only one in which self-reported information is gathered from interviewees, which involves the following important assumptions:

1. That individuals socializing at sites are willing to report information to trained interviewers about their personal sexual and injection drug use behavior,

2. that requesting verbal, anonymous informed consent, assuring confidentiality, and designing close-ended questionnaires minimizes self-presentation bias, and

3. that site managers allow patrons at their site to be interviewed for the PLACE study.

Combined with site level information gathered during the previous step, the PLACE method identifies specific sites where HIV/AIDS prevention programs should be focused to reach key members of the underlying sexual and injection drug use networks. These data are used to assist in developing HIV/AIDS prevention programs tailored to the needs of the community and the characteristics of the local epidemic.

4.2 Protocol Decisions

1. Sample Size and Over-Sampling

For most assessments, 960 completed interviews with a representative sample of patrons is sufficient to describe the characteristics and behavior of men and women socializing at sites and to determine if there has been an important change in behavior when baseline results are compared with follow-up results. Small changes in behavior and changes among small sub-groups with fewer than 200 respondents in a group cannot be detected even if 960 interviews are conducted.

The PLACE Steering Committee decides in Step 1 whether or not to target certain key populations. If such populations have been identified, additional interviews may be needed to provide separate estimates for those important key populations unlikely to be sufficiently represented in a simple cross-sectional sample of people socializing at a representative sample of sites. Key populations are preferably defined by site-based criteria such as the sub-group of people socializing at sites where sex workers solicit, the sub-group who socialize at sites that stay open past midnight, or the sub-group who socialize at the sites most frequently reported by community informants. However, key populations can also be defined by demographic or behavioral criteria to include injection drug users, young women age 15 to18, mobile populations, or men who have sex with men.

2. Selecting Sites where Interviews will be Conducted

Interviews with site patrons are performed at approximately 40 sites. Sites are selected for individual interviews using a systematic fixed interval sampling strategy with the probability of selection proportional to the size of the site. Large sites can potentially be selected more than once. This sampling strategy produces a self-weighted sample in which every individual socializing at eligible sites has equal probability of being selected for an individual interview and ensures that the selected sites will be geographically distributed throughout the Priority Prevention Area.

In some PPAs, there may be sites named by many key informants or sites where certain types of activities are reported that were identified by the PLACE Steering Committee as high interest sites. If desirable, additional interviews may be conducted at these sites and analyzed separately or combined with other data using appropriate weights.

In PPAs where 60 or fewer sites are eligible for individual interviews, all sites are selected.

3. Selecting Respondents for Each Site

The number of individual interviews performed at each selected site depends on the number of clusters selected at that site. Most selected sites will have one cluster, or 24 individual interviews. Large sites that were selected more than once by the interval selection strategy will have more than one cluster of interviews performed. For sites with fewer than 24 socializing patrons, all patrons are interviewed. A total of 960 individual interviews with socializing patrons take place.

If 60 or fewer sites are eligible for selection and individual interviews are performed at all sites, the 960 individual interviews are distributed equally among all sites. Using this method results in slightly fewer individual interviews performed at each site compared to the interval selection strategy described above. However, by using this method, summary characteristics of individual behavior are produced for all sites found within the PPA.

4. How to Select Respondents at a Site

Potential respondents are identified systematically using an interval sampling strategy and are selected from all locations within a site. This strategy for selecting individuals to interview yields a systematic sample representative of all patrons socializing at the sites. The gender distribution of individual interviews performed at each site reflects the overall ratio of men-to-women socializing at all verified sites.

4.3 Data Collection

Prior to the beginning of interviews with individuals socializing at sites, interviewers receive training for this step of the method. Interviews with individuals socializing at sites take place no more than one week after site verification interviews.

Interviewers visit sites in teams of two at busy times, which most often are during the evening or night. When sites such as certain bars or streets are deemed unsafe at their busy times, interviewers complete the field work earlier in the day to maintain safe working conditions. When approaching an individual, interviewers explain the purpose of the study and the types of questions that will be asked and request verbal informed consent before proceeding with the interview. It is often necessary to request that the respondent move to a different location at the site, away from their peers and others at the site, to preserve privacy and encourage truthful responses. The interview typically lasts 15 to 20 minutes and is the only step in which self-reported information about sexual behavior is gathered from interviewees.

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.

4.4 Getting Results

1. Data Entry

The data from the Questionnaire for Individuals Socializing at Sites are entered into Epi Info. Tables summarizing the characteristics of socializing patrons are produced. The tables produced from the data collected during this step include the following information about socializing patrons, by gender:

• Sociodemographic information including age, location of residence, employment status, and education level

• Self-reported information about new partnerships, condom use, commercial sex, injection drug use (if applicable), and other behaviors

• Exposure to HIV/AIDS prevention programs in area.

The final outputs of this step are tables summarizing the characteristics of socializing patrons. At the end of this step, fieldwork is complete.

Table 4.1: Summary of individual interview protocol

Exercises

Exercise 6

Objective

To become familiar with the data collected from interviews with individuals socializing at sites and to utilize this data to confirm whether interventions introduced at these sites will reach people with a high rate of new partner acquisition.

Instructions

In this exercise, you will use data collected from individuals socializing at some of the verified sites where people meet new sexual partners. In Step 4, interviewers visit selected sites to interview a target number of men and women. Information from these interviews is collected using the Questionnaire for Individuals Socializing at Sites. Data from each of these questionnaires is saved in the "Socializing Individuals" dataset. Both the Questionnaire for Individuals Socializing at Sites and the "Socializing Individuals" dataset are provided for you, below. The questionnaire and dataset provided contain most of the variables currently used in the PLACE protocol. You can obtain a complete copy of the questionnaire from the PLACE manual, found on the MEASURE publications webpage at http://www.cpc.unc.edu/measure/resources/publications/ms-05-13. 

You may choose to use the "Socializing Individuals" dataset in Epi Info or in HTML format if you wish to import it into another statistical package. You will need to use a statistical package such as Epi Info to complete the analysis for this exercise because there are too many observations for you to answer the questions simply by counting. Epi Info is the preferred statistical package for this exercise because this public domain software is available for download at no cost from the United States Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov.

The questions you will be answering may be answered separately for each site, but for this exercise you will be looking at a composite of data from all interviews with socializing individuals.

Form

• Questionnaire for Individuals Socializing at Sites: [PDF]

Data

• "Socializing Individuals": [Epi-Info]

Use Epi Info or another statistical package to answer the following questions using the "Socializing Individuals" dataset. Instructions for completing the analysis in Epi Info are available if you need them, here.

1. What is the total number of men and women who were approached for an interview?

2. What is the total number of men and women who refused to be interviewed?

3. What is the total number of men and women who were successfully interviewed?

4. What is the age distribution of the men and women who were interviewed?

5. By gender, what percent of patrons (socializing individuals) interviewed:

   • do not live in the Priority Prevention Area?

   • visit the site daily?

   • have never had sex?

   • have ever used a condom?

   • used a condom with their most recent new sexual partner?

   • had more than one sexual partner in the past 12 months? 

     • Of patrons who have had more than one sexual partner in the past 12 months and also had at least one regular sexual partner, what percentage did not use a condom the last time they had sex with a regular partner?

   • had one or more new sexual partners in the past 12 months?

   • had one or more new sexual partners in the past 4 weeks?

   • gave or exchanged money for sex in the past 4 weeks?

6. What percent of male patrons (socializing individuals) interviewed:

   • had sex with a man (MSM) in the past 4 weeks?

   • had a symptom of an STI in the past 4 weeks?

7. Make a two by two table that examines condom use during first sex with most recent new partner among all respondents who had a new partner in the past 12 months. Compare condom use among respondents who did talk with a peer health educator with condom use among those who did not talk with an educator at the site in the past 3 months.

8. By gender, what proportion of youth aged 15-19:

   • ever had sex?

   • ever used a condom?

   • had a new sexual partner in the past 4 weeks?

Answers

Exercise 6

1. What is the total number of men and women who were approached for an interview?

   486 men and 498 women were approached for an interview, making a total of 984 people approached.

2. What is the total number of men and women who refused to be interviewed?

   7 men and 16 women refused to be interviewed, making a total of 23 people who refused to be interviewed.

3. What is the total number of men and women who were successfully interviewed?

   479 men and 480 women were successfully interviewed, making a total of 959 people who were successfully interviewed. Two people were approached who were under age 15 and thus too young to be interviewed.

4. What is the age distribution of the men and women who were interviewed?

   Men interviewed ranged in age from 15 to 61 years old, with a mean of 28 years. Women interviewed were between 15 and 69 years of age with a mean age of 27 years.

5. By gender, what percent of patrons (socializing individuals) interviewed:

   • do not live in the Priority Prevention Area?

     27.1 percent of women did not live inside the Priority Prevention Area of Port City and 29.2 percent of men did not live inside Port City.

   • visit the site daily?

     22.1 percent of men visited the site where they were interviewed daily and 23.8 percent of women visited the site where they were interviewed daily.

   • have never had sex?

     3.1 percent of men had never had sex and 6.7 percent of women had never had sex.

   • have ever used a condom?

     64.7 percent of men had ever used a condom and 66.7 percent of women had ever used a condom.

   • used a condom with their most recent new sexual partner?

     52.0 percent of men had used a condom with their most recent sexual partner and 55.6 percent of women had used a condom with their most recent sexual partner.

   • had more than one sexual partner in the past 12 months?

     72.4 percent of men had more than one sexual partner in the past 12 months and 62.9 percent of women had more than one sexual partner in the past 12 months.

     • Of patrons who have had more than one sexual partner in the past 12 months and also had at least one regular sexual partner, what percentage did not use a condom the last time they had sex with a regular partner?

       47.2 percent of men who had at least one regular sexual partner and who also had more than one sexual partner in the past 12 months did not use a condom the last time they had sex with a regular partner and 43.1 percent of women who had at least one regular sexual partner and who also had more than one sexual partner in the past 12 months did not use a condom the last time they had sex with a regular partner.

   • had one or more new sexual partners in the past 12 months?

     76.0 percent of men had a new sexual partner in the past 12 months and 72.5 percent of women had a new sexual partner in the past 12 months.

   • had one or more new sexual partners in the past four weeks?

     48.9 percent of men had a new sexual partner in the past 4 weeks and 45.8 percent of women had a new sexual partner in the past 4 weeks.

   • gave or exchanged money for sex in the past 4 weeks?

     7.1 percent of men gave or exchanged money for sex in the past 4 weeks and 21.0 percent of women gave or exchanged money for sex in the past 4 weeks.

6. What percent of male patrons (socializing individuals) interviewed:

   • had sex with a man (MSM) in the past 4 weeks?

     5.2 percent of men interviewed had sex with another man in the past 4 weeks.

   • had a symptom of an STI in the past 4 weeks?

     39.25 percent of men interviewed had at least one STI symptom in the past 4 weeks (188 out of 479)

7. Make a two by two table that examines condom use during first sex with most recent new partner among all respondents who had a new partner in the past 12 months. Compare condom use among respondents who did talk with a peer health educator with condom use among those who did not talk with an educator at the site in the past 3 months.

   	Talked with peer educator at this site in past 3 months
   	Yes	No
   Used condom during first sex with last new partner	93	381	474
   Did not use condom during first sex with last new partner	19	219	238
   	112	600	712

8. By gender, what proportion of youth aged 15-19:

   • ever had sex?

     94.4 percent of boys aged 15 to 19 had ever had sex and 87.2 percent of girls aged 15 to 19 had ever had sex.

   • ever used a condom?

     69.7 percent of boys aged 15 to 19 had ever used a condom and 70.2 percent of girls aged 15 to 19 had ever used a condom.

   • had a new sexual partner in the past 4 weeks?

     52.8 percent of boys aged 15 to 19 had a new sexual partner in the past 4 weeks and 37.2 percent of girls aged 15 to 19 had a new sexual partner in the past 4 weeks.