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Program Areas

15 HIV prevalence
Goals: All aspects of HIV and STI prevention programs funnel into a single goal: to reduce the transmission of HIV and other STIs and mitigate the effect on affected individuals and their families. If programs are successful in bringing about changes in exposure to HIV infection, then HIV incidence will decline as well. 
Key Questions:  
Challenges: Decreased transmission of HIV means fewer new cases. However, it is very difficult for regular monitoring systems to measure new cases¾incidence data generally come only from sophisticated and expensive longitudinal cohorts. National monitoring and evaluation (M&E) systems therefore tend to use cross-sectional prevalence data to monitor the spread of infection. But with chronic diseases such as HIV, prevalence data are not reliable as a proxy indicator for recent infections. This is especially so when the data come from sentinel surveillance systems built around selected populations, such as women in antenatal clinics (ANCs). ANC data for HIV are biased by mortality, a reduction in fertility in HIV-positive women, and other factors. Second generation surveillance aims to make better use of data generated by sentinel surveillance, partly by changing sampling and analysis strategies so that data better reflect more recent infections (see appendix IV for a more detailed description of second generation surveillance). The indicators described here make use of those principles. One of the constraints of sentinel HIV surveillance in generalized epidemics is that few sentinel systems provide any data on men. Other proxy measures of impact in men can be used, for example, the incidence of self-reported or clinical STIs. Since interventions aimed at reducing the spread of HIV should also have an impact on STIs¾and a much more rapid one at that¾STI measures can be useful as indicators of recent changes in risk behavior. Measures of HIV and STI incidence and prevalence provide an idea of the health impact of the HIV epidemic and of programs designed to limit it. Mortality data also provide powerful impact indicators. It is recognized, however, that the impact of HIV and AIDS extends beyond health or even mortality. Indicators of incapacity and orphanhood provide a crude idea of the potential social and economic impact of the epidemic at a household level; they will grow in importance as the epidemic matures. More refined indicators are needed to measure the social and economic impact of HIV and AIDS¾and of the success of national AIDS programs in mitigating that impact. It is hoped that Methods Packages will be expanded to include additional measures of socioeconomic impact as new methodologies are developed. 

USAID | UNAIDS | UNICEF | WHO | CDC | US Census Bureau
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