Population-based survey tools with the necessary questions to determine whether respondents have been tested for HIV and if they know their status. Evaluators should count the total number of all individuals who received HIV testing and know their results from any service delivery point, including fixed health care facilities, such as hospitals, public and private clinics; specialized care sites (e.g., antenatal care, preventing mother-to-child transmission, male circumcision or TB sites); standalone sites not associated with medical institutions; and mobile testing, such as outreach, door-to-door services, and workplace testing events (PEPFAR, 2009). Data should be collected, reviewed, and cleaned continuously at the facility or community level. The indicator should be further disaggregated by sex and age subgroups (15-19, 20-24, etc.) and, where data are available, by type of test, test result (positive or negative), and, in areas of concentrated epidemics, membership in other most-at-risk subpopulations.

Data Source(s):

Population-based survey tools, such as the AIDS Indicator Survey (AIS), Demographic and Health Survey (DHS), or Multiple Indicator Cluster Survey (MICS).

Purpose:

This indicator measures progress in implementing HIV testing and counseling services. For persons who know their HIV status, the indicator serves as a proxy for their having received counseling. In order to protect themselves against HIV and to avoid infecting others, people should know their HIV status. A person’s knowledge of their HIV status is also a critical in making the decision to seek treatment (WHO/UNICEF/UNAIDS, 2011). This indicator provides a measure of the effectiveness of interventions that promote HIV testing and counseling, which is important where people (especially young people) may feel that there are barriers to accessing services related to issues around sexuality (UNAIDS, 2008).

Issue(s):

This indicator does not provide information to distinguish whether the number of people having an HIV test is limited by the availability of testing services or whether the testing services are underutilized and why. While knowing their HIV status is a proxy for persons having received counseling, the indicator does not provide information on the quality of the counseling and whether clients were referred and received follow-up services (PEPFAR, 2009). Where scaling up of testing and counseling is happening quickly, population-based surveys conducted every few years will not capture annual progress.

Gender Implications:

Women’s access to and use of voluntary testing and counseling services may be limited by cultural gender norms and related barriers.  Women may have less mobility, fewer resources to pay for health services, fear the stigma associated with visiting facilities that offer HIV services, and may be reluctant to be seen by male health care providers.  Lack of female health care providers may deter women from accessing services.  Women who are married or believe they are in a monogamous relationship may have low perceived risk of exposure to HIV. Furthermore, positive test results for women may have serious repercussions ranging from partner violence, social and economic isolation, to outright abandonment. Women who test positive for HIV also may not be  compliant with prophylaxis, treatment, and approaches for preventing mother-to-child transmission for fear of being stigmatized as having HIV.  The UNAIDS (2010) agenda for women, girls, and gender equality calls for increasing access and networks for women, particularly targeting women at the community level to strengthen HIV prevention efforts that include voluntary testing and counseling.

References:

PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR.  https://www.k4health.org/toolkits/igwg-gender/president%E2%80%99s-emergency-plan-aids-relief-next-generation-indicators-reference