HIV prevalence among young people (15-24)
The percent of young people aged 15-24 who have been tested for HIV and have positive test results.
As a percentage, this indicator is calculated as:
(Number of young people aged 15-24 tested whose HIV test results are positive / Number of young people aged 15-24 tested for HIV) X 100
Nationally or regionally representative community-based survey tools with the necessary questions to determine whether respondents have been tested for HIV and if they know their status. Community-based surveys can be the most accurate source of data on HIV prevalence for young people in the general population. For cost and efficiency reasons this method is best used if there is a generalized HIV epidemic with prevalence at or above 5% (WHO 2004).
Evaluators can also count the total number of all individuals who received HIV testing and know their results from any service delivery point, including fixed health care facilities such as hospitals; public and private clinics; specialized care sites (e.g., antenatal care, preventing mother-to-child transmission, male circumcision or TB sites); stand-alone sites not associated with medical institutions; and mobile testing, such as outreach, door-to-door services, and workplace testing events (PEPFAR, 2009).
Data should be collected, reviewed, and cleaned continuously at the facility or community level. The indicator should be further disaggregated by sex and age subgroups (15-19, 20-24, etc.) and, where data are available, by type of test, test result (positive or negative), and, in areas of concentrated epidemics, membership in other most-at-risk subpopulations.
Nationally or regionally representative community-based surveys, population-based surveys such as (DHS/AIS), behavioral surveillance survey (BSS), clinic or facility testing records
This indicator allows assessment of progress toward eradicating HIV infection because the highest rates of new HIV infections typically occur among young adults (PEPFAR 2009).
Patterns in HIV prevalence for young people are a better indication of recent trends in HIV incidence and risk behavior. In older populations shifts in HIV prevalence are slow to reflect changes in the rate of new infections because the average duration of infection is long. Furthermore, declines in HIV prevalence can reflect saturation of infection among those individuals who are most vulnerable and rising mortality, rather than behavior change. Thus, reductions in HIV incidence associated with genuine behavior change should first become detectable in HIV prevalence figures for 15–19-year-olds. Where available, parallel behavioral surveillance survey data should be used to aid interpretation of trends in HIV prevalence (PEPFAR 2009).
Other indicators which are also used to capture the rates of new infection are HIV prevalence among pregnant women 15-24 years old.
There is the potential for participation bias within community-based surveys. People at higher risk of HIV infection have an increased likelihood of being missed by community and population-based surveys. Most-at-risk populations such as intravenous drug users, sex workers, truck drivers, and military or police may not be counted because they live outside of households. For facility-based monitoring, there may be potential participation bias since those who present at clinics to get tested may not be representative of the population.
There is also the risk of a lack of continuity in community-based surveys, as they are costly and time consuming to deliver, which can lead to variation in the scope and format of successive surveys. This can lead to the inability to compare data on the same population (WHO 2004).
Young women’s access to and use of voluntary counseling and testing services may be limited by cultural gender norms and related barriers. Less mobility, fewer resources to pay for health services, fear the stigma associated with being a sexually active adolescent and visiting facilities that offer HIV services may all contribute to young women not seeking HIV testing. Further, lack of female health care providers may deter women from accessing services. Women who are married or believe they are in a monogamous relationship may have low perceived risk of exposure to HIV. Furthermore, positive test results for women may have serious repercussions ranging from partner violence, social and economic isolation, to outright abandonment. Women who test positive for HIV also may not be compliant with prophylaxis, treatment, and approaches for preventing mother-to-child transmission for fear of being stigmatized as having HIV. The UNAIDS (2010) agenda for women, girls, and gender equality calls for increasing access and networks for women, particularly targeting women at the community level to strengthen HIV prevention efforts that include voluntary testing and counseling.
HIV/AIDS Survey Indicators Database, https://www.statcompiler.com/en/
Accessed July 27, 2011.
United Nations, 2003. Indicators for Monitoring the Millennium Development Goals: Definitions, Rationale, Concepts, and Sources, New York.
World Health Organization. National AIDS Programmes. A guide to indicators for monitoring and evaluating national HIV/AIDS prevention programmes for young people. 2004.
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://pdf.usaid.gov/pdf_docs/Pcaac330.pdf
UNGASS Online Indicator Registry (for HIV/AIDS), http://indicatorregistry.org/.