Data needed for an effective HIV response

Data needed for an effective HIV response

Assessing the HIV-related health issues for AGYW requires various forms of data, not simply on HIV incidence, prevalence, morbidity and mortality. It requires gathering information on:

  • The HIV epidemic amongst AGYW, including in different locations and amongst different sub-populations
  • The biological, behavioural and structural factors that drive HIV acquisition and transmission
  • The challenges they face in accessing HIV prevention as well as accessing and adhering to treatment and maintaining care
  • The current national HIV response, including gaps and challenges, an
  • The programmes required to respond adequately to the HIV-related health rights of AGYW

This information and evidence on the HIV epidemic amongst AGYW, including issues related to gender equality and other structural barriers, must be described in a national strategic plan, investment case, Global Fund funding request and/or other relevant strategy. Following from that, it must then be applied to the design, implementation, monitoring and evaluation of programmes.

Critical types of data for tailoring a strategic HIV response to the needs of AGYW
  • Updated disaggregated HIV epidemiological data (HIV and TB prevalence, HIV and TB incidence, morbidity, and mortality) by sex, age group, marital status, AGYW in and out of school, geographical area and other demographic factors over time is necessary for linking epidemiological trends to program efforts. This should also include information on how HIV is being transmitted (e.g. not only who is newly acquiring HIV but how, when and where and by whom), including for young key populations, and on latest transmission dynamics.
  • Age disaggregated data by narrow age groups (e.g. ages 10-14; 15-19, and 20-24) rather than large age groups (10-24 years) are particularly critical for understanding the HIV dynamic among AGYW. Data on key HIV-related knowledge, attitudes and practices, such as age of first sexual experience, are prone to change quickly as AGYW age.19 Given the importance of young key populations in many countries, age-disaggregated data on key populations should be collected – at least for the adolescent age group (ages 10 – 19).
  • Data on access to and use of HIV prevention, treatment, care and support services for AGYW in the context of the HIV situation of other groups. Investments should align with other efforts on AGYW, requiring an understanding of existing programs and their effectiveness as well as existing providers and their capacity, particularly for community-based services.
  • Data on behavioural factors affecting HIV risk which include both individual and relational factors (age-disparate sex, multiple partnerships, sex work and transactional sex, early sexual debut, alcohol and drug use, and limited risk perception).
  • Structural factors preventing optimal delivery of services. These factors include social and gender norms on relationships and gaps in knowledge and risk perception, human rights violations, including stigmatization, discrimination, gender inequality, punitive laws and policies as well as other structural factors, including access to secondary and tertiary education, unethical or unscientific health services, and labour migration that can influence health-seeking behaviours and overall HIV trends. Such data is critical for addressing the cross-cutting human rights and gender-related factors influencing services and care. One critical source of data are Violence Against Children surveys (VACs) that collect data on sexual, physical and emotional violence as well as data on risk factorsS.
  • Data on health systems-related capacity and constraints at the national, sub-national and community levels that could be affecting the HIV burden of AGYW.
Global Fund (2017) Adolescent Girls and Young Women in High-HIV Burden Settings: Technical Brief
UNAIDS identifies the following factors that may influence high HIV incidence amongst young women:

Behavioural factors linked to the behaviour of young women and male partners, such as

  • Age disparate sex
  • Multiple partnerships
  • Sex work
  • Sexual exploitation of adolescent girls
  • Transactional sex
  • Early sexual debut
  • Gaps in knowledge and limited personalized risk perception

Biological factors linked to their own biological susceptibility and that of male partners, such as

  • Biological susceptibility of women
  • Biological susceptibility of adolescent girls
  • High HIV viral load amongst male partners
  • Low prevalence of male circumcision
  • Harmful practices
  • Other infections

Structural factors are contextual factors that contribute causally and may also be linked to barriers to access to services, such as

  • Harmful social and gender norms, gender inequality and unequal power dynamics
  • Low secondary school attendance
  • Labour migration and spousal separation
  • Barriers to access to sexual and reproductive health care services
  • Orphanhood
  • Child sexual abuse
  • Gender-based violence
  • Marriage patterns, including low marriage rates and early marriage.
UNAIDS (2017) HIV Prevention Among Adolescent Girls and Young Women
Critical Enablers