Young injecting drug users reached by HIV/AIDS prevention services

Export Indicator

The percentage of young injecting drug users (IDUs) who are reached by HIV/AIDS prevention services.
What it measures

This indicator is an estimate of the percentage of young IDUs who, in the preceding month, were reached by  outreach prevention services, plus the number of IDUs who are young people enrolled in drug-dependence treatment, either long-term drug-free or substitution therapy. Prevention services should include the sexual prevention of HIV/AIDS, i.e. the provision of condoms, in addition to the use of clean needles or drug treatment, because the epidemic spreads to the general population through sexual contact. A comprehensive programme should include both prevention via needle exchange as well as sexual prevention. A programme providing only sexual prevention should not be considered. In the interest of clarity and comparability of data the services that are included and those that are not included should be clearly noted. The range of services that can reduce the risk of HIV among IDUs includes:
• HIV information, education and communication (IEC) programmes;
• condom distribution;
• counselling on risk reduction;
• counselling testing for HIV;
• disinfection programmes;
• needle and syringe programmes;
• agonist pharmacotherapy programmes;
• HIV treatment and care.

Rationale
Numerator

The number of young IDUs who in the past month were reached by outreach prevention services, plus the number of IDUs receiving drug-dependence treatment, either long-term drug-free1 or substitution therapy. The numerator should consist of individuals, not the number of contacts, including repeat contacts or the number of needles and syringes or condoms distributed.

Denominator

The estimated number of young IDUs who are regularly injecting.

Calculation
Method of measurement

For the numerator, service statistics from outreach projects and programmes and from treatment facilities; for the denominator, prevalence estimation methods for the number of young IDUs who are regularly injecting.
The selection of relevant information for the calculation of the indicator is a consultative process involving all stakeholders in the fi eld of HIV/AIDS prevention among IDUs. It is necessary, therefore, to discuss the collection of information and to plan for future data collection in a technical working group specifi cally dedicated to HIV/AIDS and injecting drug use. If there is no such working group, one should be established. The working group has to determine the sizes of the numerator and the denominator. Essential information may be lacking or the available information may be unreliable. In such circumstances the working group should develop mechanisms and standards for monitoring and data collection in the future.  In order to determine the numerator it is necessary to review data of all the government and nongovernmental treatment and outreach programmes and projects in the country concerned. This usually requires the establishment of an inventory of all ongoing governmental and nongovernmental projects and programmes that provide face-to-face services (either information and counselling only, or information, counselling and the provision of clean needles/syringes, or drug-dependence therapies such as methadone treatment and abstinence-based programmes). The collation of data from these programmes and projects is necessary. If a country has no inventory of ongoing programmes and projects it is strongly recommended that a database be rapidly established. Data from all relevant services are combined in order to calculate the numerator for this indicator. However, when this indicator is being reported on a national basis the types of services available, and the types included in the numerator, should be specified. It may be problematic to ask for an age breakdown that results in enquiries about possibly illegal activities. A general age bracket of “under 25” is therefore recommended as a core indicator, and an additional breakdown for persons aged under 18 years is suggested as optional where appropriate. A number of methods may be used to estimate of the actual size of a specifi c population vulnerable to HIV infection, in this case the number of injecting drug users in a country. These methods are designed to produce estimates of the sizes of populations that are hidden or hard to reach.

Measurement frequency
Disaggregation

Age group:

Education: N/A

Gender: N/A

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator gives a strong programmatic measure of the availability of harm reduction services to young IDUs. The denominator data could have a considerable margin of error, however, as estimates are derived from different sources. These may be biased or extrapolated from data obtained at the subnational level. If there are different sources of data the best available estimate has to be used.  It is necessary to keep track of the number of IDUs reached through outreach, to avoid double counting and to protect and maintain confi dentiality with respect to the identifi cation of IDUs, especially vis-a-vis law enforcement agencies where these activities are legally problematic. For example, it may be illegal in some places to distribute needles to people under 18, whereas many outreach services function on a “no questions asked” basis and therefore do not collect any data on their clients. Drug-dependence treatment programmes are more likely to keep age data.

Further information