AIDS Behav (2006) 10:607–617 DOI 10.1007/s10461-006-9113-7 ORIGINAL PAPER HIV-Related Sexual Behavior in Urban, Rural and Border Areas of Burkina Faso Maria Khan · Lisanne Brown · Nicolas Nagot · Souleymane Salouka · Sharon S. Weir Published online: 20 May 2006 C  Springer Science+Business Media, Inc. 2006 2006 Introduction As HIV/AIDS prevention resources are scarce, program planners must first reach areas at highest risk of HIV trans- mission (Weir et al., 2003). “High transmission areas” are often locations where increased social mixing intersects with increased commercial activity (e.g., hotels for truck drivers at the intersection of major commercial routes, bars near trading centers and migrant worker residences; Mwizarubi, Hamel- mann, & Nyamuryekung’e, 1997). Nationally-representative surveys provide serological evidence that HIV prevalence is highest in urban areas (UNAIDS/WHO, 2004), where “high transmission areas” are concentrated. However, such areas are also found outside urbanized settings. Even within relatively small rural areas, large differences in prevalence by residence have been observed (Boerma, Urassa, Klokke, Senkoro, & Ng’weshemi, 1999; Serwadda et al., 1992). In a 1997 review of urban-rural differences in sexual behavior and HIV risk, Cara¨ el (1997) emphasized that simultaneous epidemics occur within both urban and non-urban areas, and the interplay between these epidemics as a result of pop- ulation mobility is important. Especially considering that M. Khan () · S. S. Weir MEASURE Evaluation Project, Carolina Population Center and Department of Epidemiology, University of North Carolina, Room 306, 123 W. Franklin St., Chapel Hill, NC, 27516-2524 e-mail: maria khan@unc.edu L. Brown MEASURE Evaluation Project, Department of International Health and Development, Tulane University, New Orleans, LA N. Nagot · S. Salouka Centre Muraz, Bobo-Dioulasso, Burkina Faso the majority of the population in sub-Saharan Africa lives in non-urban areas, understanding HIV transmission risk in both urban and non-urban areas is warranted (FAO, 2003). The present study examined differences in HIV-related sexual behavior among urban, rural and border areas of Burkina Faso. Burkina Faso has the second highest HIV prevalence in West Africa after its southern neighbor, Cˆ ote d’Ivoire, with estimates of HIV prevalence varying from about 1% in rural areas to about 4% in some urban towns and regions that border Cˆ ote d’Ivoire (INSD, 2003). Pop- ulation mobility between urban and rural areas and across international borders is assumed to be a particularly impor- tant determinant in the West African HIV/AIDS epidemic (Lydie and Robinson, 1998; UNAIDS/IOM, 1998), and Burkina Faso historically has experienced substantial in- ternal and international migration. About 602,000 people migrated internationally between 1988–1992, most often to Cˆ ote d’Ivoire and Ghana in search of work (INSD, 2003). Since September 2002, Cˆ ote d’Ivoire has experienced a se- vere political and social crisis that has led to the return of many Burkinab´ e who were born abroad (INSD, 2003). This in-migration will potentially impact the HIV-epidemics of both urban and rural areas of Burkina Faso. Behavioral data were needed to interpret urban and non- urban HIV prevalence estimates and to best plan interven- tion strategies appropriate for each setting in Burkina Faso. Therefore, the Burkina Faso National AIDS Control Pro- gram (CNLS) piloted implementation of the Priorities for Local AIDS Control Efforts (PLACE) method, a relatively novel assessment tool designed to identify places where HIV/AIDS prevention programs should be implemented (Weir, Morroni, Coetzee, Spencer, & Boerma, 2002), in two Burkina Faso Health Districts. The method was developed based on epidemiologic models indicating that among the most important determinants of sexual transmission of HIV Springer