Recent epidemiologic data show that the number of new AIDS cases worldwide is starting to decline, including a 30 percent reduction in maternal-to-child transmission (MTCT) between 2004 to 2010 (UNAIDs, 2010a).  Yet the devastation of AIDS persists with over 20 million deaths, tens of millions of children orphaned, and about 33 million people living with HIV (UNFPA, 2011a). AIDS continues to be a leading cause of death globally and the primary cause of death in Africa. Sexually transmitted infections (STIs) – including HIV – and poor sexual and reproductive health (RH) are driven by similar root causes including gender inequality, poverty, lack of access to health services and resources, and social marginalization of the most vulnerable populations. At the close of the 2001 UN General Assembly Special Session (UNGASS), 189 member nations adopted the Declaration of Commitment on HIV/AIDS reflecting a global consensus on a comprehensive framework to achieve the Millennium Development Goal (MDG) #6. to combat HIV/AIDs by halting and beginning to reverse the epidemic by 2015 (UNGASS, 2009).  In 2006, MDG Target 6.C was added calling for the achievement of universal access to treatment, prevention, care and support by 2010. Key related goals have included the UNGASS targets for universal access to antiretroviral (ARV) programs and the G8 leaders’ commitment to provide as universal as possible AIDS treatment by 2010. UNAIDS, UNICEF, WHO and UNFPA have partnered with individual countries to continue rapid scale up of quality, comprehensive prevention of maternal-to-child transmission (PMTCT) services with the goal of eliminating MTCT of HIV by 2015. The Global Health Initiative (GHI) has prioritized the need for coordinated action to combat HIV/AIDS given that 3 million new people are infected with HIV each year and AIDS is the leading cause of death of women of reproductive age (GHI, 2010).

STIs and HIV/AIDS are integrally linked to sexual and RH. STIs (e.g., gonorrhea, syphilis, chlamydia, and HPV) constitute a significant health burden and can cause pregnancy-related complications, including spontaneous abortions, premature birth, stillbirth, congenital infections, pelvic inflammatory disease, cervical cancer and infertility. Next to complications of pregnancy and childbirth, STIs are the leading cause of health problems for women of reproductive age (UNFPA, 2011b). STIs also increase the risk of transmission of HIV. The majority of HIV infections are transmitted sexually, followed (depending on the setting) by needle sharing among IV drug users and MTCT during pregnancy, childbirth and breastfeeding.  Women are an especially vulnerable population for STIs and HIV/AIDS. When AIDS emerged in the 1980s, it mostly affected men, but today women account for nearly half of all people living with HIV and 76 percent of young people (15-24 years) living with HIV are female. Most of the women who suffer from HIV/AIDS are in the prime of their lives, and being identified as HIV positive may result in gender-based violence, unemployment, abandonment or the loss of other human rights and freedoms. The death of women from AIDS deprives families and communities of their care and productivity, and often leaves their children without any means of support (UNFPA 2011c).

The feminization of the HIV/AIDS epidemic underscores the cultural and gender norms that shape behavior and limit women’s options to protect and care for themselves. Many women are vulnerable to HIV even though they do not practice high-risk behaviors and marriage itself can be a risk factor (UNFPA, 2006). Women who are pregnant or who have recently given birth are at even greater risk to HIV due to physical changes that increase susceptibility to infection and low likelihood of condom use in marriage and especially during pregnancy. In 2009, UNAIDS brought together a global task force to develop an operational plan for an Action Framework on Women, Girls, Gender Equality and HIV that is being rolled out presently at the country level (UNAIDS 2010b).

Programs addressing STIs and HIV/AIDS generally focus on four primary areas: (1) prevention (e.g., PMTCT, IV drug use, male circumcision, pre- and post-exposure prophylaxsis, condom use, sexual and other risk reduction, testing and counseling, and targeting most at risk populations); (2) support care for people living with HIV/AIDs and orphaned and vulnerable children; (3) treatment with ARV therapy, nutrition and related services; and (4) health system strengthening. Integration of STI and HIV/AIDS services with maternal and child health, family planning, and related health programs is a growing collaborative effort. This database includes technical areas covering integration of HIV services, specifically Women’s Nutrition and HIV and Family Planning and HIV.

The involvement of numerous international partners in the global effort to combat HIV/AIDS has required the elaboration of consensus frameworks, approaches, and indicators for monitoring and evaluating (M&E) the wide array of regional, national, and local programs. Since 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has worked to coordinate the US government worldwide response to HIV/AIDS and harmonize planning, M&E, and reporting processes. The New Generation PEPFAR indicators that went into effect in 2010 replaced all previous versions with added emphasis on program coverage, quality, and measures of cost-effectiveness (PEPFAR, 2010). Nearly all of the 34 indicators selected for this database are consistent with the PEPFAR indicators, with the addition of an AIDS program effort index and several indicators drawn from the WHO/UNFPA (2008) guide on monitoring universal access to RH and the WHO/UNICEF/UNAIDS (2011) guide on indicators for M&E on the health sector response to HIV/AIDS.

Additional sources and subsets of indicators include The Global Fund (2011) Framework that has identified two sets of ‘top ten’ indicators for the combined areas of HIV/AIDs, TB and malaria: one set for routine Global Fund reporting and the second set for medium term outcome and impact. Three of the indicators in this database are in the routine set and three are in the medium term outcome and impact set. Focusing on treatment, WHO, UNAIDS and partners have developed three interlinked patient monitoring systems with M&E indicators for HIV/ARV therapy, maternal and child health and PMTCT, and TB/ARV therapy (UNAIDS, 2008; WHO, 2009).  The online UNGASS Indicator Registry (for HIV/AIDS) and the UNAIDS (2010c) Guidelines on Construction of Core Indicators include a wide range program and country-level surveillance indicators many of which have been harmonized with the PEPFAR indicators. For technical guidance on interventions and indicators for PMTCT, see UNAIDS (2010a).

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References:

Global Fund et al., 2006, Monitoring and Evaluation Toolkit: HIV/AIDS, Tuberculosis, and Malaria, Geneva: The Global Fund.

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://www.pepfar.gov/documents/organization/81097.pdf

UNAIDS 2008, FINAL REPORT, 12th Meeting of the UNAIDS Monitoring and Evaluation Reference Group, Lugano (Switzerland), 17-20 November.

UNAIDS, 2010a, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS.

UNAIDS, 2010b, Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV, Geneva, UNAIDS.

UNAIDS, 2010c, Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on Construction of Core Indicators, Geneva: UNAIDS.

UNGASS 2009, Guidelines on Construction of Core Indicators, Geneva: UNAIDS

UNGASS, 2001, Declaration of Commitment on HIV/AIDS

UNGASS Online Indicator Registry (for HIV/AIDS), http://indicatorregistry.org/

UNFPA, 2011a, Strengthening Efforts to Prevent HIV, New York: UNFPA. http://www.unfpa.org/hiv/index.htm

UNFPA, 2011b, Breaking the Cycle of Sexually Transmitted Infections, New York: UNFPA. http://www.unfpa.org/rh/stis.htm

UNFPA, 2011c, Preventing HIV/AIDS: Protecting the Health of Women and Girls, New York: UNFPA. http://www.unfpa.org/hiv/women.htm

UNFPA, 2006, Keeping the Promise: An Agenda for Action on Women and AIDS, New York: UNFPA.

WHO/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO.

WHO/UNAIDS/UNICEF/The Global Fund, 2009, Three Interlinked Patient Monitoring Systems for HIV care/ART, MCH/PMTCT and TB/HIV, Geneva: WHO.

WHO and UNFPA, 2008, National-level monitoring of the Achievement of universal access to reproductive health, Geneva: WHO.

MEASURE Evaluation, 2018. Community-Based Indicators for HIV Programs. https://www.measureevaluation.org/community-based-indicators/indicators