HIV prevalence in people who inject drugs

Export Indicator

Percentage of people who inject drugs who are living with HIV
What it measures

It measures progress on reducing HIV prevalence among people who inject drugs.

Rationale

People who inject drugs typically have the highest HIV prevalence in countries with either concentrated or generalized epidemics. In many cases, prevalence among these populations can be more than double the prevalence among the general population. Reducing prevalence among people who inject drugs is a critical measure of a national-level response to HIV.
Countries with generalized epidemics may also have a concentrated sub-epidemic among people who inject drugs. If so, it is valuable for them to calculate and report on this indicator for those populations.

Numerator

Number of respondents who test positive for HIV.

Denominator

Number of respondents tested for HIV.

Calculation

Numerator / Denominator

Method of measurement

UNAIDS and WHO Working Group on Global HIV/AIDS and STI Surveillance: Guidelines among populations most at risk for HIV (WHO/UNAIDS, 2011).
This indicator is calculated using data from HIV tests conducted among respondents in the primary sentinel site or sites or in the context of a surveillance survey.
The sentinel surveillance sites used for the calculation of this indicator should remain constant to allow for the tracking of changes over time.
For further information, please consult the following website:
http://www.unaids.org/en/HIV_data/Methodology/default.asp
Revised guidelines on HIV surveillance for key populations at higher risk are available at:
http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2011/20110518_Surveillance_among_most_at_risk.pdf

Measurement frequency

Annual

Disaggregation

Age-group:

< (less than) 25 years

> (greater than) 25 years

Gender:

Female

Male

Strengths and weaknesses

In theory, assessing progress in reducing the occurrence of new infections is best done through monitoring changes in incidence over time. However, in practice, prevalence data rather than incidence data are available.
In analysing prevalence data of people who inject drugs for the assessment of prevention programme impact, it is desirable not to restrict analysis to young people but to report on those persons who are newly initiated to behaviours that put them at risk for infection (e.g. by restricting the analysis to people who have initiated injecting drug use within the last year). This type of analysis also has the advantage of not being affected by the effect of ART in increasing survival and thereby increasing prevalence.
If prevalence estimates are available disaggregated by greater than and less than one year of injecting drugs countries are strongly encouraged to report this disaggregation in their Country Progress Report, and to use the comments field for this indicator in the reporting tool to present disaggregated estimates.
Due to difficulties in accessing people who inject drugs, biases in sero-surveillance data are likely to be far more significant than in data from a more general population, such as women attending antenatal clinics. If there are concerns about the data, these concerns should be reflected in the interpretation.
An understanding of how the sampled population(s) relate to any larger population(s) sharing similar risk behaviours is critical to the interpretation of this indicator. The period during which people belong to a key population is more closely associated with the risk of acquiring HIV than age. Therefore, it is desirable not to restrict analysis to young people but to report on other age groups as well.
Trends in HIV prevalence among people who inject drugs in the capital city will provide a useful indication of HIV-prevention programme performance in that city. However, it will not be representative of the situation in the country as a whole.
The addition of new sentinel sites will increase the samples representativeness and will therefore give a more robust point estimate of HIV prevalence. However, the addition of new sentinel sites reduces the comparability of values. As such it is important to use consistent sites when undertaking trend analyses.
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.

Further information

For further information, please consult the following links:
http://www.unaids.org/en/HIV_data/Methodology/default.asp
Revised guidelines on HIV surveillance for key populations at higher risk: WHO/UNAIDS Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on surveillance among populations most at risk for HIV. Geneva, UNAIDS, 2011
(http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2011/20110518_Surveillance_among_most_at_risk.pdf).