Physical and/or sexual violence experienced by key populations (A-D)
This indicator is divided into four sub-indicators:
A. Experience of physical and/or sexual violence among sex workers.
B. Experience of physical and/or sexual violence among gay men and other men who have sex with men.
C. Experience of physical and/or sexual violence among people who inject drugs.
D. Experience of physical and/or sexual violence among transgender people.
What is measures
Progress towards reducing physical and sexual violence among key populations
Globally, high rates of HIV infection among key populations - including sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people - have brought into sharp focus the problem of gender-based violence. There is growing recognition that deep-rooted, pervasive gender inequalities, reflected in gender-based violence, shape their risk of and vulnerability to HIV infection.
Violence and HIV have been linked through direct and indirect pathways, and studies in a range of countries indicate that many sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people have experienced violence in some form or another at some point in their lives. Violence has also been demonstrated to impede HIV prevention, care and treatment services among key populations.
Number of people in a key population group (sex workers, gay men and other men who have sex with men, people who inject drugs or transgender people) who reported that either of the incidents happened to them at least once in the last 12 months
Total number of respondents from a key population group
Behavioural surveillance or other special surveys. Indicators A-D are constructed from responses to the following questions among respondents who report belonging to a key population group (i.e., sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people).
- In the last 12 months, how many times has anyone physically hurt you, such as hit or choked you or threatened you with a knife or other weapon (this has not happened in the last 12 months, once, 2-5 times, 6-10 times, 10 or more times, don't know, refuse to answer)?
- In the last 12 months, how many times has someone tricked you, lied to you or threatened you in order to make you have sex when you didn't want to (this has not happened in the last 12 months, once, 2-5 times, 6-10 times, 10 or more times, don't know, refuse to answer)?
Every two years
- A, B, C, D: age (<25 years, 25+ years).
- A and C: gender (male, female, transgender).
- D: gender: transman, transwoman, other.
These indicators directly measure the experience of physical and/or sexual violence among key populations (i.e., sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people). The indicators are calculated from responses to two questions. The questions were developed by technical experts based on previously validated measures of violence among key populations. Changes in the indicator should be interpreted as follows: an increase in the prevalence indicates a rise in physical and/or sexual violence among key populations, signaling the need for mitigating actions, whereas a decrease in the prevalence indicates progress towards reducing violence against key populations.
Respondent-driven sampling (RDS) is used to implement integrated biobehavioural surveys. This sampling methodology allows researchers to access, in a systematic way, members of typically hard-to-reach populations who may not otherwise be accessible. Because RDS is a probability sampling method, researchers are able to provide unbiased population estimates and measure the precision of those estimates. RDS can be especially successful at rapid recruitment in dense urban environments, but in contexts where the hard-to-reach populations are not well-networked - or in contexts where the stigma associated with some key populations is severe - recruitment rates using RDS may be unpredictable.
Other disadvantages to using RDS relate to the difficulties that may arise when analyzing collected data. For instance, since RDS must take into account weighting for network size and recruitment patterns, the statistical strength of the sample as it applies to the target population decreases if participants only recruit people who share the same characteristics as themselves.
Buller AM, Devries KM, Howard LM, Bacchus LJ. Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis. PLoS Med. 2014 (Mar); 11(3):e1001609.
Bhattacharjee P, Morales G, Kilonzo T, Dayton R, Musundi R, Mbole J et al. Can a national government implement a violence prevention and response strategy for key populations in a criminalized setting? A case study from Kenya. J Intl AIDS Soc. 2018. 21(S5):e25122.
Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P et al. A systematic review of the correlates of violence against sex workers. Am J Public Health. 2014 (May);104(5):e42-e54.
For more on the methods, including RDS, and the survey instruments for the integrated biobehavioural survey, see: https://www.who.int/publications/i/item/978-92-4-151301-2