Fear of HIV transmission through casual contact with a person living with HIV (Not Final)
It measures progress towards reducing fear of HIV transmission through casual contact with a person living with HIV, a key driver of HIV-related stigma.
Fear of infection has been identified as an important driver of HIV-related stigma in a number of settings. Contact with saliva has consistently been found to be a source of fear among the general population in multiple contexts. This fear persists in many contexts, even when HIV knowledge is relatively high. The persistence of this unjustified fear of contact with saliva continues to drive the stigmatization process, and manifests in avoidance behaviours, such as not wanting to share meals, or having separate dishes and cutlery for people living with HIV within the household. These actions can then foster internalised stigma and feelings of shame among people living with HIV, which have been linked with poor adherence to treatment and engagement in HIV care and support services.
This indicator measures the irrational fear of contracting HIV through casual, or non-invasive, contact with a person living with HIV; it focuses on situations that are ubiquitous across cultures (i.e. sharing utensils or a glass of water, sneezing, and kissing) and often lead to stigma that is particularly harmful to people living with HIV. This indicator can be used to assess the impact of programmatic interventions that attempt to increase knowledge of how HIV is and is not transmitted and to reduce stigmatizing and discriminatory behaviors due to fear. The indicator can also be used to measure progress over time and influence programming and funding decisions. This indicator should be measured alongside the GARPR indicator on correct knowledge of HIV transmission, as the knowledge indicator includes a measure of myth rejection related to HIV transmission (Can a person get HIV by sharing food with someone who is infected?). This indicator can also be assessed alongside an additional question on fear of HIV transmission through contact with sweat (Do you fear that you could contract HIV if you come into contact with the sweat of a person living with HIV (Yes / No / Don’t Know or Not Sure / Not applicable).
*This indicator has been deemed relevant and promising by the UNAIDS MERG, but requires additional data collection prior to finalization. Please submit any results when using this indicator to Anne Stangl (firstname.lastname@example.org), so that the indicator development can continue.
Number of respondents (aged 15-49 years) who respond “Yes” to the question
Those who have never heard of HIV and AIDS should be excluded from the numerator and denominator. Participants who respond “Don’t Know/Not sure” and those who refuse to answer should also be excluded from the analyses. It is important to assess the proportion of eligible survey participants who respond “Don’t Know/Not sure” or who refuse to answer the questions. A high proportion of Don’t Know/Not sure responses and refusals will reduce the precision of the results and may indicate problems with applicability of the question within the survey setting.
Number of all respondents aged 15-49 years who have heard of HIV
Numerator / Denominator
Population-based surveys (Demographic and Health Survey, AIDS Indicator Survey, Multiple Indicator Cluster Survey or other representative survey)
This indicator is constructed from responses of respondents in a general population survey who have heard of HIV to the following prompted question:
- Do you fear that you could contract HIV if you come into contact with the saliva of a person living with HIV? (Yes; No; Don’t know/Not sure; Not applicable)
Every 3-5 years
Age (15-19, 20-24, 25-49)
Gender (Female, Male)
A key strength of this indicator is its applicability across a wide range of contexts. This indicator intends to capture the underlying reason, fear of contact with saliva, for refusing or avoiding casual contact with people living, as opposed to contextually specific situations in which people may fear becoming infected with HIV through casual contact with people living with HIV.
A potential weakness of this indicator is that in some instances it may be unable to clearly distinguish between lack of knowledge of HIV transmission pathways and actual fear of transmission and/or stigmatizing attitudes/beliefs towards people living with HIV. For example, it is possible that a respondent with correct knowledge on how HIV is transmitted may not be willing to share a glass of water with a person living with HIV due to stigmatizing attitudes rather than due to fear of HIV transmission through saliva or sweat.
This question is not applicable to people who know that they are living with HIV. Survey populations with high HIV prevalence may either artificially reduce reported fear levels, or, if the “Not Applicable” response option is chosen, have smaller numbers of eligible respondents which may reduce the precision of the results. Inclusion of a “Not Applicable” question response for people who are HIV positive may be of ethical concern within surveys where HIV status is not collected as use of this response option may inadvertently disclose their status to survey field staff.
For further information on stigma and discrimination, and efforts to measure their prevalence, please see:
- Thematic Segment on Non-Discrimination, 31st meeting of the UNAIDS Programme Coordinating Board. Background Note. (www.unaids.org/en/media/unaids/contentassets/documents/pcb/2012/20121111...)
- Stangl, A., Brady, L., Fritz, K. Technical Brief: Measuring HIV Stigma and Discrimination. Washington DC and London: International Center for Research on Women and London School of Tropical Medicine; STRIVE, 2012 (http://strive.lshtm.ac.uk/system/files/attachments/STRIVE_stigma%20brief...).
- Stangl, A., Lloyd, J., Brady, L. et al. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? Journal of the International AIDS Society. 2013, vol 16 Supplement (www.jiasociety.org/index.php/jias/issue/view/1464).
For further information on DHS/AIS methodology and survey instruments, please visit: www.measuredhs.com