This indicator shows the extent to which condoms are used by people who are likely to have higher-risk
sex (i.e. change partners regularly). However, the broader signifi cance of any given indicator value will
depend upon the extent to which people engage in such relationships. Thus, levels and trends should be interpreted carefully using the data obtained on the percentages of people that have had more than one sexual partner within the last year.

The maximum protective effect of condoms is achieved when their use is consistent rather than occasional. The current indicator does not provide the level of consistent condom use. However, the alternative method of asking whether condoms were always/sometimes/never used in sexual encounters with nonregular partners in a specifi ed period is subject to recall bias. Furthermore, the trend in condom use during the most recent sex act will generally refl ect the trend in consistent condom use.

This indicator gives a picture of levels of higher-risk sex. If people have only one sexual partner, the
change will be captured by changes in this indicator. However, if people simply decrease the number of
sexual partners they have, the indicator will not reflect a change, even though potentially this may have a
significant impact on the epidemic spread of HIV and may be counted a programme success. Additional
indicators may need to be selected to capture the reduction in multiple sexual partners in general.

Countries where very few young people have sex before the age of 15 might opt to use an alternative
indicator: percentage of young women and men aged 20–24 who report their age at sexual initiation as
under 18 years. The advantage of using the reported age at which young people first had sexual intercourse (as opposed to the median age) is that the calculation is simple and allows easy comparison over time. The denominator is easily defined because all members of the survey sample contribute to this measure.

It is difficult to monitor change in this indicator over a short period because only individuals entering
the group, i.e. those aged under 15 at the beginning of the period for which the trends are to be assessed, can influence the numerator. If the indicator is assessed every two to three years, it may be better to focus on changes in the levels for the 15–17 age group. If it is assessed every five years, the possibility exists of looking at the 15–19 age group.

In countries where HIV-prevention programmes encourage virginity or delaying of first sex, young
people’s responses to survey questions on this issue may be biased, including a deliberate misreporting of age at which they first had sex.

The belief that a healthy-looking person cannot be infected with HIV is a common misconception that
can result in unprotected sexual intercourse with infected partners. Correct knowledge about false beliefs of possible modes of HIV transmission is as important as correct knowledge of true modes of transmission. For example, the belief that HIV is transmitted through mosquito bites can weaken motivation to adopt safer sexual behaviour, while the belief that HIV can be transmitted through sharing food reinforces the stigma faced by people living with AIDS.

This indicator is particularly useful in countries where knowledge about HIV and AIDS is poor because it
allows for easy measurement of incremental improvements over time. However, it is also important in other countries because it can be used to ensure that pre-existing high levels of knowledge are maintained.

Surveying most-at-risk populations can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be refl ected 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.

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.

The belief that a healthy-looking person cannot be infected with HIV is a common misconception
that can result in unprotected sexual intercourse with infected partners. Rejecting major misconceptions
about modes of HIV transmission is as important as correct knowledge of true modes of transmission.
For example, belief that HIV is transmitted through mosquito bites can weaken motivation to adopt safer
sexual behaviour, while belief that HIV can be transmitted through sharing food reinforces the stigma
faced by people living with AIDS.

This indicator is particularly useful in countries where knowledge about HIV and AIDS is poor because it
permits easy measurement of incremental improvements over time. However, it is also important in other countries as it can be used to ensure that pre-existing high levels of knowledge are maintained.

The defi nitions of orphan/non-orphan used here—i.e., child aged 10–14 years as of the last birthday
both of whose parents have died/are still alive—are chosen so that the maximum effect of disadvantage
resulting from orphanhood can be identifi ed and tracked over time. The age-range 10–14 years is used
because younger orphans are more likely to have lost their parents recently so any detrimental effect on
their education will have had little time to materialize. However, orphaned children are typically older
than non-orphaned children (because the parents of younger children have often been HIV-infected for
less time) and older children are more likely to have left school.

Typically, the data used to measure this indicator are taken from household-based surveys. Children not
recorded in such surveys—e.g., those living in institutions or on the street—generally, are more disadvantaged and are more likely to be orphans. Thus, the indicator will tend to understate the relative disadvantage in educational attendance experienced by orphaned children.

This indicator does not distinguish children who lost their parents due to AIDS from those whose parents died of other causes. In countries with smaller epidemics or in the early stages of epidemics, most orphans will have lost their parents due to non-HIV-related causes. Any differences in the treatment of orphans according to the known or suspected cause of death of their parents could infl uence trends in the indicator. However, to date there is little evidence that such differences in treatment are common.

The indicator provides no information on actual numbers of orphaned children. The restrictions to double orphans and to 10–14 year-olds mean that estimates may be based on small numbers in countries with small or nascent epidemics.

It is important that life-skills based HIV education is initiated in the early grades of primary school and
then continued throughout schooling with contents and methods being adapted to the age and experience
of the students.

The indicator provides useful information on trends in the coverage of life-skills based HIV education
within schools. However, the substantial variations in the levels of school enrolment must be taken into
account when interpreting (or making cross-country comparisons of) this indicator. Consequently,
primary and secondary school enrolment rates for the most recent academic year should be included in
the supporting information provided for this indicator.

Complementary strategies that address the needs of out-of-school youth will be particularly important in
countries where school enrolment rates are low.

The indicator is a measure of coverage. The quality of education provided may differ by country and over
time.
 

This indicator should only be monitored in settings with high HIV prevalence (5% or greater). The
indicator does not measure the needs of the household or the orphans and vulnerable children. Additional questions could be added to measure expressed needs of families caring for orphans. The indicator implicitly suggests that all households with orphans and vulnerable children need external support; some orphans and vulnerable children are more in need of external support than others. Therefore, it is important to disaggregate the information by other markers of vulnerability such as socioeconomic status of the household, dependency ratio, head of the household, etc.

If sample sizes permit, it may be useful for programmatic purposes to investigate differences between
values for this indicator for orphans versus other vulnerable children. It may also be –useful to look at
data disaggregated by age and duration of orphanhood, as both play a key role in determining the type of
support needed. For example, an orphan whose parent(s) died 10 years ago will need support of a different kind from one whose parent(s) died within the past year.

When considering the four types of support separately, data for school-related assistance should be limited
to children aged 5–17.

 Accessing and/or surveying most-at-risk populations can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population 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.

The inclusion of these indicators for reporting purposes should not be interpreted to mean that these
services alone are suffi cient for HIV prevention programmes for these populations. The set of key interventions described above should be part of a comprehensive HIV prevention programme, which also includes elements such as provision of HIV prevention messages, (e.g. through outreach programmes and peer education), treatment of sexually transmitted diseases, opioid substitution therapy for injecting drug users, and others. For further information on the elements of comprehensive HIV prevention programmes most-at-risk populations please see the Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access.

This indicator asks about services accessed in the past 12 months. If you have data available on another time period, such as the last 3 or 6 months or the last 30 days, please include this additional data in the comments section of the reporting tool.

It has been recommended that the issue of quality and intensity of reported services among most-at-risk
populations be addressed more explicitly in terms of criteria for the measurement of the components of
provided services. Taking into account the complexity of this element of measurement, particularly within
the context of most-at-risk populations, the development of such criteria requires an intensive process of
information gathering, synthesis and recommendations formulation. This process was initiated in 2008 and will inform the review of the UNGASS reporting system which is scheduled for 2010. In the meantime, it is recommended that the guidelines mentioned below be referred to as reference documents that can facilitate interpretation of the collected data from a quality and intensity perspective.

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.

Accessing and/or surveying most-at-risk populations can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population 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.

Tracking most-at-risk populations over time to measure progress may be diffi cult 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.

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.