HIV testing in sex workers

Export Indicator

Percentage of sex workers who received an HIV test in the past 12 months and know their results
What it measures

 

It measures progress in implementing HIV testing and counselling among sex workers

Rationale

In order to protect themselves and to prevent infecting others, it is important for sex workers to know their HIV status. Knowledge of one’s status is also a critical factor in the decision to seek treatment. Note: Countries with generalized epidemics may also have a concentrated sub-epidemic among one or more most-at-risk populations. If so, they should calculate and report this indicator for those populations.

Numerator

Number of sex workers who have been tested for HIV during the last 12 months and who know their results.

Denominator

Number of sex workers included in the sample.

Calculation

Numerator / Denominator

Method of measurement

Behavioural surveillance or other special surveys.
Respondents are asked the following questions:
1. Have you been tested for HIV in the last 12 months?
If yes:
2. I don’t want to know the results, but did you receive the results of that test?
Whenever possible, data for sex workers should be collected through civil society organizations that have worked closely with this population in the field.
Access to survey respondents as well as the data collected from them must remain confidential.
Disaggregations
• Sex (female, male, transgender)
• Age (<25/25+)

Measurement frequency

Biennial

Disaggregation

Age-group:

< (less than) 25 years

> (greater than) 25 years

Gender:

Female

Male

Strengths and weaknesses

Accessing and/or surveying sex workers can be challenging. Consequently, data obtained may not be based on a representative sample of the national, sex workers being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be reflected in the interpretation of the survey data. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included in the report submitted with this indicator.
If the data are subnational, please provide the disaggregation by administrative area in the comment field. Please submit the digital version of any available survey reports using the upload tool.
Tracking sex workers over time to measure progress may be difficult due to mobility and the hard-to-reach nature of these populations with many groups being hidden populations. Thus, information about the nature of the sample should be reported in the narrative to facilitate interpretation and analysis over time.
Several countries have in previous reporting rounds reported HIV prevalence among subpopulations of transgender women through the additional comments field in the GARPR online reporting tool. This demonstrates that the data are feasible to obtain in different settings.
To maximize the utility of these data, it is recommended that the same sample used for the calculation of this indicator be used for the calculation of the other indicators related to these populations.
This indicator is most meaningful in settings where testing scale-up is relatively recent. People who tested more than 12 months ago and know they are positive will be considered “uncovered” by this indicator construction. Ideally, surveys should ask why respondents did not test in the past 12 months. If they report that they know their HIV status to be positive, they should not be included in the denominator. This indicator will be formally changed post-2015; we will ask countries that can to report against this indicator while omitting known HIV-positive persons from the denominator.

Further information

For further information, please consult the following references:
A framework for monitoring and evaluating HIV prevention programmes for most-at-risk populations. Geneva, UNAIDS, 2007.
Practical guidelines for intensifying HIV prevention: towards universal access. Geneva, UNAIDS, 2007.
Operational Guidelines for Monitoring and Evaluation of HIV Programmes for Sex Workers, Men who have Sex with Men, and Transgender People. MEASURE Evaluation (www.cpc.unc.edu/measure/publications/ms-11-49a).