Percent of men and women aged 15-49 who received an HIV test in the last 12 months and who know their results
The percentage of women and men aged 15-49 who had an HIV test in the last 12 months and know their results. In a population-based survey, after assuring respondents that the interview does not want to know their HIV status, respondents are asked if they have been tested for HIV in the past 12 months and if they know the results of the test (WHO/UNICEF/UNAIDS, 2011). For young people aged 15 to 24, they may be first asked if they have had sexual intercourse in the last 12 months. Those replying affirmatively are then asked whether they were tested in the last 12 months, and, if yes, whether they know the results of their HIV test (UNAIDS, 2008). Those replying affirmatively to the above questions are counted in the numerator. For additional information on this and closely related indicators see PEPFAR (2009); UNAIDS (2008); WHO et al., (2006); WHO/UNICEF/UNAIDS (2011).
Indicator is calculated as:
(The number of respondents aged 15-49 who had an HIV test in the last 12 months and who know their results/ Total number of respondents aged 15-49) x 100
Population-based survey tools with the necessary questions to determine whether respondents have been tested for HIV and if they know their status. Evaluators should 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); standalone 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.
Population-based survey tools, such as the AIDS Indicator Survey (AIS), Demographic and Health Survey (DHS), or Multiple Indicator Cluster Survey (MICS).
This indicator measures progress in implementing HIV testing and counseling services. For persons who know their HIV status, the indicator serves as a proxy for their having received counseling. In order to protect themselves against HIV and to avoid infecting others, people should know their HIV status. A person’s knowledge of their HIV status is also a critical in making the decision to seek treatment (WHO/UNICEF/UNAIDS, 2011). This indicator provides a measure of the effectiveness of interventions that promote HIV testing and counseling, which is important where people (especially young people) may feel that there are barriers to accessing services related to issues around sexuality (UNAIDS, 2008).
Factors that may influence whether or not a person accesses HIV testing and counseling services include: the location of services; the availability and cost of transport to reach these services; perception of the confidentiality of the testing process and test results; and the perceived attitude of the staff. The indicator is restricted to HIV tests performed in the last 12 months so that program managers can compare with previous years to assess changes over time. It can be useful to explore any patterns in testing, for example whether there were more tests conducted in a particular season or month when there were campaigns, or whether many more people are being tested in particular health facilities or in the communities (WHO/UNICEF/UNAIDS, 2011). This indicator can also be helpful for projecting programmatic needs, such as test kits and other staffing resources, however, because this indicator is intended to count individuals and not tests, data would need further interpretation for use in commodities planning (PEPFAR, 2009).
This indicator does not provide information to distinguish whether the number of people having an HIV test is limited by the availability of testing services or whether the testing services are underutilized and why. While knowing their HIV status is a proxy for persons having received counseling, the indicator does not provide information on the quality of the counseling and whether clients were referred and received follow-up services (PEPFAR, 2009). Where scaling up of testing and counseling is happening quickly, population-based surveys conducted every few years will not capture annual progress.
The validity of the data may be affected by reporting bias because some respondents may not want to admit to having taken an HIV test since this may be regarded as an admission that they may have engaged in sexual or other high-risk behaviors. Conversely, in settings where getting tested for HIV has been heavily promoted as a responsible thing to do, some people may say they have been tested when in fact they have not. The conditions under which respondents are interviewed are likely to affect reporting bias, particularly if data are collected in the presence of other people than rather than in strict privacy. Repeat testing is common practice among most HIV testing and counseling programs and it is important to interpret the aggregated data with caution (PEPFAR, 2009). Despite these possible biases, this indicator gives an idea of the percentage of people who are likely to know their HIV status (UNAIDS, 2008).
In settings where HIV prevalence is higher among more mobile or difficult to reach populations, these groups may be missed in population-bases surveys. In some countries, a significant proportion of testing and counseling services are provided by community-based organizations or unregistered organizations, which often may not be included as part of national statistics. These organizations should be encouraged to register with national authorities so all data on testing and counseling can be reflected in the national statistics (WHO/UNICEF/UNAIDS, 2011). In low-level and concentrated epidemics, this indicator may yield extremely low percentages if measured in the general population. In such settings, this indicator may be more helpful if applied to measure HIV testing and awareness of HIV status among specific sub-populations at higher risk of infection.
Women’s access to and use of voluntary testing and counseling services may be limited by cultural gender norms and related barriers. Women may have less mobility, fewer resources to pay for health services, fear the stigma associated with visiting facilities that offer HIV services, and may be reluctant to be seen by male health care providers. 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.
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. https://www.k4health.org/toolkits/igwg-gender/president%E2%80%99s-emergency-plan-aids-relief-next-generation-indicators-reference
UNAIDS, 2008, Core Indicators for National AIDS Programmes: Guidance and Specifications for Additional Recommended Indicators, Geneva: UNAIDS http://data.unaids.org/pub/BaseDocument/2009/20090305_additionalrecommendedindicators_finalprintversio_en.pdf
UNAIDS, 2010, Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV, Geneva, UNAIDS. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/agenda_for_accelerated_country_action_en.pdf
WHO/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO. http://www.who.int/hiv/data/UA2011_indicator_guide_en.pdf
WHO, UNAIDS, The Global Fund, CDC, USAID, UNICEF, MEASURE Evaluation, US Dept. of State: OGAC, 2006, Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis, and Malaria, Geneva: WHO. http://www.hivpolicy.org/Library/HPP000485.pdf