HIV prevalence among key populations (A-E)

Export Indicator

Percentage of specific key populations living with HIV
What it measures

Progress on reducing HIV prevalence among key populations

Rationale
Sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people and people in prisons and other closed settings typically have higher HIV prevalence than the general population in all  epidemic contexts. Addressing HIV among these populations is an important component of the national response.
Numerator

Number of people in a specific key population who test positive for HIV

Denominator

Number of people in a specific key population tested for HIV

Calculation

Numerator/denominator

Method of measurement

A–D.This indicator is calculated using data from HIV tests conducted among respondents in the sentinel site(s) or participants in biobehavioural surveys. The sentinel surveillance sites used for calculating this indicator should remain constant to allow for tracking changes over time.

E. This indicator is calculated using data from HIV tests conducted by prisons and other closed settings. HIV testing programme data are acceptable. Conducting surveys can be challenging and should therefore not be relied on. Testing should be conducted only with the consent of the people in prisons and other closed settings.

Measurement frequency

Annual (programme data) or every two years (biobehavioural survey).

Disaggregation
  • A, C, and E: Sex (female, male and transgender).
  • D: gender (transman, transwoman, other).
  • A–E: Age (<25 and 25+ years).
Additional information requested

A–E: If there are subnational data available, please provide the disaggregation by administrative area, city, or site in the space provided. You may also upload an Excel spreadsheet of these data instead of entering them in the online tool. Submit the digital version of any available survey reports using the upload tool.

Strengths and weaknesses
In theory, progress in reducing the number of people newly infected with HIV is best assessed by monitoring the changes in incidence over time. In practice, however, prevalence data rather than incidence data are available. In analysing the prevalence data from key populations for assessing the impact of prevention programmes, it is desirable not to restrict analysis to young people but to report on the people newly initiating behaviour that  puts them at higher risk of infection, such as by restricting the analysis to people participating in sex work for less than one year, to men who first had sex with another man within the past year or to people initiating injecting drug use within the past year. This type of analysis also has the advantage of not being affected by antiretroviral therapy increasing survival and thereby increasing prevalence.
 
Because of the difficulties in accessing key populations, biases in serosurveillance data are likely to be more significant than in data collected from a less stigmatized population, such as women attending antenatal clinics. If there are concerns about the data, the interpretation should reflect these concerns.
 
Understanding how the sampled populations relate to any larger populations sharing similar high-risk behaviour is critical to interpreting this indicator.
 
Trends in HIV prevalence among key populations in the capital city provide a useful indication of the performance of HIV prevention programmes in that city. However, they are not representative of the situation in the country as a whole.
 
The addition of new sentinel sites will increase the sample’s representativeness and therefore provide a more robust point estimate of HIV prevalence.
However, adding new sentinel sites reduces the comparability of values over time. As such, using consistent sites when undertaking trend analysis is important.
 
Surveys exclusively covering transgender people are rare. Most data for transgender communities are drawn from surveys of men who have sex with  men or sex workers. The risk environment reported in most transgender communities is great, placing transgender women at especially high riskof becoming HIV- positive and transmitting the infection. Examples from several Latin American countries demonstrate that successful surveys can be conducted in transgender communities. If transgender women are respondents in surveys of sex workers, include the data with sex workers as a disaggregation. If transgender people are respondents in surveys of gay men and other men who have sex with men, include the data under the transgender tab.
 
People in prisons and other closed settings are easily reached with services, while released individuals can be efficiently linked to appropriate care and prevention services. The HIV prevalence can be readily estimated and quickly provide information that can be acted on.
 
In settings where high-risk behaviours for HIV transmission are criminalized, there is potential for high HIV prevalence and over-interpreting the results.
Full understanding of the prison population is helpful during the analysis, especially the reasons for detention.
Further information
 
WHO/UNAIDS Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on surveillance among populations most at risk for HIV. Geneva:
 
Operational guidelines for monitoring and evaluation of HIV programmes for sex workers, men who have sex with men, and transgender people.
 
Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240052390).
 
Operational Guidelines for Monitoring and Evaluation of HIV Programmes for People who Inject Drugs. In: MEASURE Evaluation [Internet].