The basis for this report is the data countries submitted to UNAIDS in the 2010 round of the United Nations General Assembly Special Session (UNGASS) reporting on indicator 14. The Guidelines on Construction of Core Indicators (United Nations General Assembly Special Session on HIV/AIDS) stipulates the following with regard to this indicator:
Concentrated epidemics are generally driven by sexual transmission or use of contaminated injecting equipment. Sound knowledge about HIV and AIDS is an essential prerequisite if people are going to adopt behaviors that reduce their risk of infection. This indicator should be calculated separately for each population that is considered most-at-risk in a given country: sex workers, injecting drug users, and men who have sex with men.
Note: countries with generalized epidemics may also have a concentrated sub-epidemic among one or more most-at-risk populations. If so, it would be valuable for them to calculate and report on this indicator for those populations.
Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission.
Purpose: To assess progress in building knowledge of the essential facts about HIV transmission among most-at-risk populations.
Applicability: Countries with concentrated or low-prevalence epidemics, including countries with concentrated sub-epidemic within a generalized epidemic.
Data collection frequency: Every two years.
Measurement tool: Special behavioral surveys such as the Family Health International Behavioral Surveillance Survey for most-at-risk populations.
Method of measurement:
Respondents are asked the following five questions.
1. Can having sex with only one faithful, uninfected partner reduce the risk of HIV transmission?
2. Can using condoms reduce the risk of HIV transmission?
3. Can a healthy-looking person have HIV?
4. Can a person get HIV from mosquito bites?
5. Can a person get HIV by sharing a meal with someone who is infected?
Numerator: Number of most-at-risk population respondents who gave the correct answers to all five questions.
Denominator: Number of most-at-risk population respondents who gave answers, including “don’t know”, to all five questions.
Indicator scores are required for all respondents and should be disaggregated by sex and age (<25; 25+).
The first three questions should not be altered. Questions 4 and 5 may be replaced by the most common misconceptions in the country. Respondents who have never heard of HIV and AIDS should be excluded from the numerator but included in the denominator.
Scores for each of the individual questions—based on the same denominator—are required in addition to the score for the composite indicator.
Whenever possible, data for most-at-risk populations should be collected through civil society organizations that have worked closely with this population in the field. Access to survey respondents as well as the data collected from them must remain confidential.[i]
Interpretation
This indicator is particularly useful in countries where knowledge about HIV and AIDS is poor because it allows for easy measurement of incremental improvements over time. However, it is also important in other countries because it can be used to ensure that pre-existing high levels of knowledge are maintained. Surveying most-at-risk populations can be challenging. Consequently, data obtained may not be based on a representative sample of the national, most-at-risk population being surveyed. If there are concerns that the data are not based on a representative sample, these concerns should be reflected in the interpretation of the survey data. Where different sources of data exist, the best available estimate should be used. Information on the sample size, the quality and reliability of the data, and any related issues should be included in the report submitted with this indicator. To maximize the utility of these data, it is recommended that the same sample used for the calculation of this indicator be used for the calculation of the other indicators related to these populations.
The purpose of the indicator is to measure progress amongst most-at-risk populations in terms of knowledge about HIV transmission. UNAIDS requires that all countries with low-prevalence epidemics or concentrated epidemics report on the indicator and collect data on men who have sex with men, sex workers and injecting drug users. However, UNAIDS points out that also countries with generalized epidemics should collect this data in case of concentrated sub-epidemics in these groups. However, the large majority of countries with generalized epidemics fail to conduct such monitoring and/or report whatever data they may have collected. A subsequent LGBT Scorecard element will highlight data that suggest that concentrated sub-epidemics are in fact present among MSM and other sexually diverse populations in many of these countries. While general resource constraints may be the reason for this lack of monitoring it may also, arguably, reflect prevailing discrimination against MSM in those countries.
In addition to data on indicator 14, this report will highlight any relevant information on knowledge on HIV transmission for same-sex people that countries included in the narrative reports.