Conceptual framework

The conceptual framework of the present project is strongly connected to the WHO - Joint United Nations Programme on HIV/AIDS (UNAIDS) Second Generation Surveillance System (SGSS).

The SGSS includes the systematic collection and analysis of key information and data, in order to monitor the patterns in the HIV-STIs spread over the time. The present project aims to implement innovative surveillance methodologies for hard to reach populations like MSM, in line with the SGSS approach. These innovative surveillance methodologies are intended to be an effective tool in implementing on-going and systematic behavioural surveillance in the participating countries.

The conceptual framework, in line with the SGSS approach, identifies which behaviours should be monitored and in which populations.

In communities with concentrated epidemics, surveillance systems should be targeted on high-risk behaviour groups, in this case MSM. This approach enables to accurately monitor the respective groups and understand if and how the rates are changing over the time, as well as measure the impact of implemented prevention activities. Potential links between members of these groups and the general population should be also monitored. In terms of behaviours, scientific literature and WHO-UNAIDS publications stressed the importance of monitoring key behaviours and attitudes strictly connected to the spread of HIV-STIs epidemic. Information on health seeking behaviours gathered through behavioural surveillance may also help to understand the behavioural patterns in the study population and to improve the access to testing and care by the MSM accordingly.

The GARP (Global AIDS Response Progress Reporting) indicators represent a relevant approach in this case, namely:

• proportion of MSM who are HIV-infected (GARP 1.14)
• proportion of MSM who received an HIV test in the last 12 month (GARP 1.13)
• proportion of MSM reporting the use of a condom the last time they had anal sex with a male partner (GARP 1.12)
• proportion of MSM reached with HIV prevention programmes (GARP 1.11)

In addition, HIV-STIs epidemic patterns, as well as MSM behaviours, could be strongly influenced by specific characteristics of the environment, in terms of type of venues attended by the MSM population, health Services and so on. For that reason, ecological aspects of the environment are also included, analysed and interpreted in the study, as well as the epidemiological trends related to the sexual health. This will help the countries in monitoring the epidemic and at the same time provide them with relevant information on how to improve sexual health and prevention activities targeting the MSM population.


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