HIV prevalence among key populations (A-E)

Export Indicator

Percentage of specific key populations living with HIV
What it measures

This indicator is divided into five subindicators:

A. HIV prevalence among sex workers

B. HIV prevalence among men who have sex with men

C. HIV prevalence among people who inject drugs

D. HIV prevalence among transgender people

E. HIV prevalence among prisoners


Progress on reducing HIV prevalence among key populations

 

Rationale

A. Sex workers typically have higher HIV prevalence than the general population in both concentrated and generalized epidemics. In many cases, the prevalence among these populations can be more than twice the prevalence among the general population. Reducing the prevalence among sex workers is a critical measure of a national-level response to HIV.

B. Men who have sex with men typically have the highest HIV prevalence in countries with either concentrated or generalized epidemics. In many cases, the prevalence among these populations can be more than twice the prevalence among the general population. Reducing the prevalence among men who have sex with men is a critical measure of a national-level response to HIV.

C. People who inject drugs often have high HIV prevalence in countries with either concentrated or generalized epidemics. In many cases, the prevalence among these populations can be more than twice the prevalence among the general population. Reducing the prevalence among people who inject drugs is a critical measure of a national-level response to HIV.

D. Transgender communities often have higher HIV prevalence than the general population in many settings. In many cases, the prevalence is more than twice that of the general population. Reducing the prevalence among transgender people is an important measure for monitoring the national HIV response.

E. In many cases, the HIV prevalence among prisoners is greater than the prevalence among the general population. Addressing HIV among prisoners is an important component of the national response.

Countries with generalized epidemics may also have a concentrated subepidemic among one or more key populations at higher risk. If so, calculating and reporting on this indicator for these populations would be valuable for them.

Numerator

Number of people in a specific key population who test positive for HIV

Denominator

Number of people in a specific key population tested for HIV

Calculation

Numerator/denominator

Method of measurement

A–D. UNAIDS and WHO Working Group on Global HIV/AIDS and STI Surveillance. Guidelines among populations most at risk for HIV. Geneva: World Health Organization and UNAIDS; 2011.

This indicator is calculated using data from HIV tests conducted among respondents in the sentinel site(s) or participants in biobehavioural surveys.

The sentinel surveillance sites used for calculating this indicator should remain constant to allow for tracking changes over time.

E. This indicator is calculated using data from HIV tests conducted by prisons and other closed settings. HIV testing programme data are acceptable. Conducting surveys can be challenging and should therefore not be relied on. Testing should be conducted only with the consent of the prisoners.

Measurement frequency

Annual

Disaggregation
  • A, C, D and E: sex (female, male and transgender) 
  • A–E: age (<25 and 25+ years) 
  • A-E: Cities and other administrative areas of importance
Additional information requested

A–E: If there are subnational data available, please provide the disaggregation by administrative area, city, or site in the space provided. Submit the digital version of any available survey reports using the upload tool.

Strengths and weaknesses

In theory, progress in reducing the number of people newly infected with HIV is best assessed by monitoring the changes in incidence over time. In practice, however, prevalence data rather than incidence data are available. In analysing the prevalence data from key populations for assessing the impact of prevention programmes, it is desirable not to restrict analysis to young people but to report on the people newly initiating behaviour that puts them at higher risk of infection, such as by restricting the analysis to people participating in sex work for less than one year, to men who first had sex with another man within the past year or to people initiating injecting drug use within the past year. This type of analysis also has the advantage of not being affected by antiretroviral therapy increasing survival and thereby increasing prevalence.

If prevalence estimates are available, disaggregated by greater than and less than one year in sex work, one year of sexual activity with other men or one year of injecting drugs, countries are strongly encouraged to report this disaggregation in their country progress report and to use the comments field in the reporting tool for this indicator to present disaggregated estimates.

Because of the difficulties in accessing key populations, biases in serosurveillance data are likely to be more significant than in data collected from a less stigmatized population, such as women attending antenatal clinics. If there are concerns about the data, the interpretation should reflect these concerns.

Understanding how the sampled populations relate to any larger populations sharing similar high-risk behaviour is critical to interpreting this indicator. The period during which people belong to a key population is more closely associated with the risk of acquiring HIV than their age. It is therefore desirable not to restrict analysis to young people but to report on other age groups as well.

Trends in HIV prevalence among key populations in the capital city provide a useful indication of the performance of HIV prevention programmes in that city. However, they are not representative of the situation in the country as a whole.

The addition of new sentinel sites will increase the sample’s representativeness and therefore provide a more robust point estimate of HIV prevalence. However, adding new sentinel sites reduces the comparability of values over time. As such, using consistent sites when undertaking trend analysis is important.

In previous reporting rounds, several countries have reported the HIV prevalence among subpopulations of transgender women through the additional comments field in the Global AIDS Response Progress Reporting online reporting tool. This demonstrates that the data are feasible to obtain in different settings.

Surveys exclusively covering transgender people are rare. Most data for transgender communities are drawn from surveys of men who have sex with men or sex workers. The risk environment reported in most transgender communities is great, placing transgender women at especially high risk of becoming HIV positive and transmitting the infection. Examples from several Latin American countries demonstrate that successful surveys can be conducted in transgender communities. If transgender women are respondents in surveys of sex workers, include the data with sex workers as a disaggregation. If transgender people are respondents in surveys among men who have sex with men, include the data under the transgender tab.

Prisoners are easily reached with services, while released individuals can be efficiently linked to appropriate care and prevention services. The HIV prevalence can be readily estimated and quickly provide information that can be acted on.

In settings in which high-risk behaviours for HIV transmission are criminalized, there is potential for high HIV prevalence and over-interpreting the results. Full understanding of the prison population is helpful during the analysis, especially the reasons for detention.

Further information

UNAIDS epidemiology publications (http://www.unaids.org/en/dataanalysis/knowyourepidemic/epidemiologypubli...).

WHO/UNAIDS Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on surveillance among populations most at risk for HIV. Geneva: World Health Organization; 2011 (http://www.unaids.org/sites/default/files/sub_landing/files/20110518_Sur...).

Operational guidelines for monitoring and evaluation of HIV programmes for sex workers, men who have sex with men, and transgender people. Chapel Hill (NC): MEASURE Evaluation; 2011 (http://www.cpc.unc.edu/measure/publications/ms-11-49a).