Indicator 5.6: "HIV testing behaviour among young people, sexually active in the last 12 months"
Proportion of sexually active young people who had an HIV test in the last 12 months and know the results.
A nationally representative general population survey.
What It Measures
This indicator aims to give an idea of the reach of HIV testing services in the general population and of the percentage of sexually active young people who are aware of their HIV status. This topic has special significance for young people because they may feel that there are barriers to accessing and using many services and facilities, particularly for sensitive concerns relating to sexual health.
The indicator can provide a measure of the effectiveness of interventions that promote voluntary counselling and testing (VCT). If the interventions are targeted at a particular subgroup it may be appropriate to restrict the indicator to this subgroup.
How to Measure It
In a general population survey, respondents are first asked if they have ever been tested for HIV. Those replying affirmatively are asked whether they were tested in the preceding 12 months and, if so, whether they know the results of the test.
This indicator should be presented separately for men and women and for the age groups 15–19, 20–24 and 15-24.
The indicator may be affected by reporting bias because respondents may not want to admit to knowing their status for fear of being pressed to disclose it. The privacy of the interview may affect this matter, i.e. respondents are more likely to be reticent if data are collected in the presence of other people than if they are collected in strict privacy.
Strengths and Limitations
This indicator has several components: young people who have a test and return for the results must consider themselves or their partners to be at risk of having contracted HIV, must know where to get a test and feel able to have it and, after the test, must want to know the results and be able to return to the testing centre to get them.
Factors that could influence a young person’s access to testing facilities are their location, the availability of transport, the cost, the person’s perception of the confidentiality of the process, and, especially, of the result, and the perceived attitude of the staff towards young people. Changes in this indicator could be associated with some or all of these factors.
Used alone, this indicator cannot show whether the number of people having an HIV test is limited by the availability of testing resources or whether the testing facilities are underutilized (and the reason for which they are underutilized). This is important to direct programmatic response: in some cases, it may be necessary to conduct campaigns aimed at raising awareness about the availability of HIV testing. However, if testing is limited because of the unavailability of tests, or poor quality of testing programmes, such campaigns would be inappropriate. The services that accompany testing are important if interventions are to be successful and behaviour change is to be achieved. Further research on testing behaviour should include a consideration of the services being offered in relation to the present indicator.
In areas where HIV is highly stigmatized, respondents may be unwilling to admit to having taken an HIV test, which may be regarded as an admission that they fear themselves to be infected. This is particularly so when the question is asked as an item in a questionnaire on risk behaviour. On the other hand, in countries where taking a test has been heavily promoted as a responsible thing to do, some people may say they have been tested when in fact they have not. Despite these possible biases the indicator gives an approximate idea of the proportion of young people who are likely to know their HIV status.
In low-level and concentrated epidemics the indicator may yield extremely low percentages if measured in the general population. If this is the case it can be used effectively in surveys of behaviour in subpopulations at higher risk of infection. However, IDUs who are not yet sexually active are not reflected in this indicator.
The indicator is restricted to tests performed in the preceding 12 months so that programme managers can see changes over time. It might be useful to tabulate also the proportion ever tested, possibly a more useful indicator in populations where there is a low prevalence of HIV infection.