Surveys surveillance and the measurement of risk: a response to Herbert Smith.

Herbert L. Smiths recent paper challenges the utility of surveys on individuals knowledge attitude and practices (KAP) related to the transmission of HIV. Smith however wrongly assumes that the surveys are carried out to document transmission modes occurring in the surveyed population and that epidemiologist use the surveys as research tools from which to draw causal conclusions about risk factors and disease. Smith misunderstands the role of surveillance in epidemiology. KAP surveys are not conducted with the goal of making inferences about the current prevalence of HIV infection but are advocated to help design the content of health education programs that is in the planning and evaluation phases of health education programs. Further they are not etiologic research tools but are valuable components of surveillance programs on behavioral practices in the general population. In closing the author commends the "Health Transition Review" for bringing to light Smiths misinterpretations of epidemiologic methods and motivations of HIV prevention programs.