Being a country categorised as having a concentrated HIV epidemic (an overall low prevalence among the general population, but potentially high prevalence among pockets of sub-populations, usually hidden), Malaysia urgently requires greater understanding of its epidemic. It is vital to establish HIV and related behavioural trends among key populations at higher risk in low prevalence epidemics, in order to develop informed, evidence-based HIV responses, in which priorities are based on objective biological and behavioural data.

Malaysia is currently undertaking an Integrated Bio-Behavioural Surveillance (IBBS) whose objective is to provide an estimate of HIV prevalence among three (3) key populations at higher risk: female sex workers, transsexuals/transgenders (Mak Nyahs) and injecting drug users. The study also aims to identify sexual and injecting drug use practices and relevant HIV knowledge, attitudes and beliefs among individuals in the aforementioned key populations at higher risk thus providing greater insight into HIV transmission dynamics among these groups.

The study design involves a respondent-driven sampling (RDS) strategy. Recruitment of participants will be based at eight community-based organisations’ operations sites around Kuala Lumpur and the Klang Valley, between June - October 2009. Roughly, between 500 – 600 samples are targeted for each of the three study populations. Data collection will be based on in-depth face-to-face interviews, as well as biological surveys using HIV Rapid Tests. Informed consent, counselling and treatment referrals will be included in the study protocol. Data analysis will be performed using the RDS Analysis Tool (RDS-AT) data management software specific for handling respondent-driven sampling data requirements.

This study is a collaborative venture between the AIDS/STI Unit and the Institute of Health Behavioural Research Ministry of Health, the Malaysian AIDS Council (MAC) and the Centre of Excellence for Research in HIV/AIDS University of Malaya (CERiA). Funds are granted by the Ministry of Health. Additional financial support for this study has also been received from the World Bank.

RDS is a chain referral system that has shown to be a very effective sampling method for hidden populations for which there is no sampling frame. It is especially designed to avoid many of the biases and problems of other non-probabilitic chain referral systems such as snowballing.