SESSION: TUWS08 Sampling and Estimating the Size of
Adolescent and Young Key Populations at Higher Risk of HIV
Using Respondent Driven Sampling
Date : 22/07/2014 (14:30-17:30 PM)
Room: Room 103 www.aids2014.org

Estimated number of adolescents aged 10-19 living with HIV by UNICEF regions, 2012
Region
Estimated number of adolescents living with HIV, 2012
Total 10-19 Females (10-19) Males (10-
19)
% female
Sub-Saharan Africa
Eastern and Southern
Africa
1,700,000
1,300,000
1,000,000
800,000
720,000
550,000
58%
59%
West and Central Africa 390,000 220,000 170,000 56%
Middle East and North Africa
South Asia
East Asia and the Pacific
Latin America and the
Caribbean
Central and Eastern Europe
& Commonwealth of the
Independent States
GLOBAL
17,000
130,000
110,000
81,000
22,000
2,100,000
9,100
62,000
55,000
35,000
11,000
1,200,000
8,300
64,000
53,000
46,000
11,000
930,000
52%
49%
51%
43%
52%
56%

www.aids2014.org

www.aids2014.org

HIV prevalence among male and female sex workers in Asia and the Pacific www.aids2014.org
Source: UNAIDS, The Gap Report, 2014

Percentage of female sex workers, men who have sex with men, and people who inject drugs who are under 25 years of age in countries with data available www.aids2014.org
Source: UNAIDS, The Gap Report, 2014

Percentage of adolescents 15-19 and young people 20-24 with comprehensive correct knowledge of HIV by sex and age in countries with available data, 2008-
2013
Females 15-19 Females 20-24
4,1
2
Samoa
4,6
7,4
Males 15-19 Males 20-24
5,2
0,6
Pakistan
5,4
5,2
11,2
13,5
13,6
9,4
Timor-Leste
Indonesia
14,7
4
10,8
27,4
23,3
24,7
25
26,7
34,5
28,3
Lao People's Democratic Republic
Nepal
Mongolia
24,6
31,7
32,7
35,6
24,2
34,7
40,9
47,5
42,8
46,2
Cambodia
46,9
41,4
Kiribati
70 60 50 40 20 10 0 0 10 30 www.aids2014.org
Source: UNICEF global databases, 2014, based on Demographic and Health Surveys (DHS),
Multiple Indicator Cluster Surveys (MICS) and other national surveys, 2008-2013.
40
45,5
51
50 60 70

Percentage of adolescents 15-19 and young people 20-24 who had first sex by age 15 by sex and age in countries with available data, 2008-2013
Males 15-19 Males 20-24
Females 15-19 Females 20-24
Mongolia
Cambodia
Kiribati
Indonesia
Timor-Leste
Lao People's Democratic Republic
Nepal
25 20 15 5 0 0 5 10
Percent (%) www.aids2014.org
Source: UNICEF global databases, 2014, based on Demographic and Health Surveys (DHS),
Multiple Indicator Cluster Surveys (MICS) and other national surveys, 2008-2013.
15 20 25

• 2013 WHO HIV treatment guidelines – children, adolescents, adults and key populations
• 2013 WHO adolescents guidelines on HIV testing and counselling and HIV care and treatment
• The Impact and Cost of the HIV/AIDS Investment Framework for Adolescents
• Post-2015 discussions on new goals and targets, with emphasis on adolescents
• 2014 WHO Strategic Information (SI) Guidance – under development, emphasis on age disaggregated data, including for adolescents and key populations
• But … changing HIV/AIDS programming landscape – integration, mainstreaming, shifting funding priorities – means need for more evidence for advocacy, policy change, and programme strategies www.aids2014.org

Type of data
Population-based surveys
Targetted surveys on key sub-populations
Routine or programme statistics
Primary source
Nationally representative household surveys, e.g. Multiple Indicator Cluster
Surveys (MICS); Demographic and
Health Surveys (DHS); AIDS Indicator
Surveys (AIS) etc.
Behavioural surveillance surveys (BSS), with or without bio-markers
(UNAIDS GARPR country reports)
Ministries of Health; National AIDS
Commissions; National AIDS Control
Programmes
HIV Estimates UNAIDS/WHO statistical models
Frequency of updates
As reports become available and through
UNICEF database updates
Every 2 years when countries submit the
GARPR reports
Annually using the
WHO/UNICEF/UNAIDS
Joint Reporting process
Every 2 years; now annually
Every 2 years Population and demographic estimates
Qualitative - enabling environment e.g. policies, strategies, funding, partnerships,etc.
United Nations Population Division
Administrative/government and partner records and reports
As needed www.aids2014.org

Indicator
Estimated number of adolescents
(aged 10 – 19)
Countries with available data, 2012
Epidemiology of HIV among adolescents
Estimated number of adolescents living with HIV, 2012 a (aged 10 – 19)
1/14
1/14 living with HIV as a % of people living with HIV, 2012 b
Estimated number of new HIV infections among adolescents a
(aged 15 – 19)
Estimated number of AIDS deaths among adolescents a (aged 15 – 19)
1/14
1/14
*Other countries have ranges and wide uncertainties that can’t be published
Countries
PNG*
PNG*
PNG*
PNG*
Data Sources: a - UNAIDS 2012 HIV and AIDS estimates; b - UNICEF analysis of UNAIDS 2012 HIV and AIDS estimates www.aids2014.org

Indicator Countries with available data
(2008-2013)
Knowledge, HIV testing and sexual behaviour among adolescents c
Countries
% of adolescents (aged 15 – 19) who have comprehensive knowledge of HIV c
Female: 18
Male: 9
Cambodia, DPRK, Indonesia,
Lao PDR, Mongolia,
Myanmar, Philippines,
Thailand, Timor Leste,
Vietnam
Mongolia % of adolescents (aged 15 – 19) with multiple partners who used a condom at last sex c
% of adolescents (aged 15 – 19) who had sex before age 15 c
% of adolescents (aged 15 – 19) who were ever tested and received results c
Female: 0
Male: 2
Female: 11
Male: 7
Female: 7
Male: 3
Cambodia, Lao PDR,
Mongolia, PNG, Philippines,
Vietnam, Timor Leste
Cambodia, Myanmar,
Philippines, Vietnam
Data Sources: c - UNICEF global databases, 2013 based on DHS, MICS and other national surveys, 2008-2013 www.aids2014.org

Indicator Countries with Countries available data
(2008-2013)
Access, coverage , quality and outcome indicators
HIV testing
HIV care & treatment ???
???
Retention
Viral suppression
HIV mortality www.aids2014.org












www.aids2014.org

Routine programme data
• Limited or lack of disaggregated data on routine programme service statistics on HIV testing, care and treatment for adolescents and young key populations
• Currently, routine programme data need additional resources for data abstraction from health facility registers
Population-based surveys
•
Most surveys (MICS, DHS) start from age 15; not 10-14
• More disaggregation possible with household survey data, but small sample sizes for
15-19 year olds cannot allow for meaningful adolescent-specific analysis
Behavioural Surveillance Surveys
•
Indicator definitions, disaggregations, study methodologies often not harmonized within and across countries, hence difficult to have any meaningful comparisons
•
Sometimes the geographic scope and target populations change from one study to another www.aids2014.org

Age at first sex, ever had an HIV test, and condom use at last sex with client among sex
workers/entertainment workers in selected countries with data available
Country Data collection sites
Sampling strategy
Age at first sex % ever had HIV test % used condom at last sex with client
Indonesia, 2011 IBBS*
(Secondary analysis)
(no information on study sample, sample size or age of respondents)
Cambodia, 2010 BSS
Female Entertainment
Workers(FEW); no information on age of respondents
Sample=1132
India, 2006 BSS
Female sex workers (no information on age of respondents)
Sample=7417
8 provinces Information not available
<15: 3-34%
15-19: 57-73%
20-24: 7-27%
15-19: 28%
20-24: 40%
25+: 37%
Phnom Penh,
Kampong Som,
Kampong
Cham, Siem
Reap and
Battambong
Stratified, two stage cluster sampling
Information not available
Two-stage cluster sampling
Mean: 18.9
Median: 18
Information not available
Median: 17 CI (13-21) Information not available
<15: 24% (19.3–28.7)
16-18: 46% (40.5–51.5)
19-21: 23% (18.5–27.7)
22-25: 6% (3.4–8.6)
>25: 1% (4.2–9.8)
15-19: 52%
20-24: 63%
25+: 68%
Information not available
Information not available
-Over 60% of adolescent key populations, had first sex by age 15-19;
-HIV testing is low;
Papua New Guinea, 2010 IBBSS
Female sex workers (age 14+ years) - 441
Male sex workers (age 9+ years)
– 96
Transgender male to female sex workers (no age specified) - 56
Port Moresby Respondent driven sampling
(RDS)
*Age disaggregated data available from secondary analysis of 2007-2009 IBBS data
**For Papua New Guinea, age of entry into sex work (age at first transactional sex)
**Women:
<11:%
11-15: 10%
16-20: 63%
21-25: 12%
>25: 14%
Information not available
Last vaginal sex:
FSW
All: 80%
<25: 74%
≥25: 85%
(GARPR 2012) www.aids2014.org

Population size & HIV estimates of adolescents and young key populations
– Unknown population size estimates
– Limited epidemiologoical data on adolescent and young key populations
– Wide uncertainties of HIV estimates for adolescents living with
HIV, new infections and AIDS-related deaths
Legal, programmatic and ethical barriers
• Age of consent laws, policies and ethical barriers to HIV programming for adolescents also hinder data collection, availability and use
– Need for parental consent for interviews;
– Contradictory laws on age of consent for marriage, sex, and access to medical services
• Discriminatory laws and criminalization of key populations behaviours www.aids2014.org

• Age disaggregation of routine programme data – access, coverage and quality of HIV testing, ART, retention and HIV-related health outcomes and mortality
• Age expansion to 10-14 years in standard household and BSS surveys – but need a decision on the specific topics/questions or indicators to include
•
Oversampling of adolescent respondents in standard household and BSS surveys to allow reasonable sample sizes
• Harmonize indicator definitions, age and other disaggregations, including study methodologies for adolescent and young key populations
• Technical guidance and support for adolescent and young key populations
HIV data collection, analysis and use
• High level advocacy needed to address legal, policy, programmatic and ethical barriers to HIV data collection and use for adolescent and young key populations www.aids2014.org

www.aids2014.org
•
•
•