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Home » DHS-7 Questionnaire Review - Archived » HIV/AIDS » Expanding population-based HIV survey eligibility to all women and men aged 50 and above
Expanding population-based HIV survey eligibility to all women and men aged 50 and above [message #1860] Fri, 04 April 2014 10:52
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Messages: 4
Registered: April 2014
Location: Geneva

1. What is the information needed?
HIV status, and HIV-related and sexual behavior data, for all adults 50 years of age and above disaggregated by age group and sex.

HIV infection in low- and middle-income countries, in particular in sub-Saharan Africa (SSA), has been viewed as a disease that is irrelevant to older adults, because it is acquired in youth and its consequences are suffered in middle age (Mills et al. 2012, Negin et al. 2012). This view is expressed in limits to age-eligibility in population-based HIV surveys, including the Demographic and Health Surveys (DHS), and the targeting of HIV prevention programs to youth or working-age adults. While there is substantial evidence in SSA on the levels of HIV infection (WHO 2010; UNAIDS 2010) as well as on the success of HIV prevention and treatment (Michielsen et al. 2010; Mermin et al. 2008), this evidence is almost entirely based on studies in young and middle-aged populations, which is usually not generalizable to older adults (Negin and Comming 2010; Negin et al. 2012; UNAIDS 2009; Knodel et al. 2003). What is more, the HIV epidemic is rapidly aging due to the survival-prolonging effects (and the transmission-reducing effects) of antiretroviral treatment (ART). For the first in the history of the epidemic large proportions of HIV-infected people will survive into ages 50 and above, increasing HIV prevalence in older adults and shifting the age distribution of the epidemic to older ages, in particular in SSA (Hontelez et al. 2012). To quantify and study this predicted demographic transition of the HIV epidemic, population-based HIV status data is critical. The DHS, and the HIV/AIDS Indicator Surveys (AIDS), are the primary source of such data in developing countries this revision of the DHS questionnaires thus provides an important opportunity to provide this needed data to the global research and development community.

2. What questions will elicit this information?
HIV testing and the questions on HIV-related information and sexual behaviors that are already used in the DHS interviews of individual men and women below the age of 50 years.

3. How will the resulting information be used?
The additional data will be used for a wide variety of studies on the demographic transition of the HIV epidemic, and to study questions on HIV acquisition and transmission in old age, as well as the economic, social and behavioral consequences of the aging of the HIV epidemic in households and communities in low- and middle-income countries.

Examples of research themes include:

• How quickly is the HIV epidemic aging in sub-Saharan Africa?
• What are the demographic, social, economic, and behavioral characteristics of older adults with HIV in sub-Saharan Africa?
• Is there a causal effect between
• How does the aging of the HIV epidemic affect household composition and health outcomes in younger household members?
• Does the inclusion of older adults in the DHS surveys increase HIV testing rates among older household members?

4. What is the priority of suggested additions compared with what is already in the questionnaires?
We do not suggest any new content to the questionnaires, but merely an extension of the age eligibility of one component of the DHS questionnaires and processes that is already in use in many countries worldwide.

5. If suggesting more than one addition, what is the priority among the suggested additions?

HIV testing has the highest priority, but the HIV-related information and sexual behavior data are also important.

6. Should the additional data be collected in all countries, or only in selected types of countries (e.g., countries with a particular type of program, countries with prevalence of a particular infection >5% or 10%)?

Ideally, the additional data should be collected in all countries that carry out DHS HIV surveys. The most important set of countries are the HIV hyper endemic countries in sub-Saharan Africa.
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