Guidelines on surveillance among populations most at risk for HIV

1. IntroductionThe overall goal of this document is to provide guidance on how to develop and maintain HIV surveillanceamong populations most at risk for HIV. Ultimately, these surveillance activities should improve the overallunderstanding of HIV in countries and improve the response to HIV.This guide complements the second generation surveillance guidelines on how to conduct HIV surveillanceactivities in low- and middle-income countries. Those guidelines recommend that all countries conduct HIVsurveillance among populations with behaviours that increase their risk for HIV, or populations most at riskfor HIV infection.<strong>Guidelines</strong> on surveillance among populations most at risk for HIV1.1. PurposeThis document provides guidance on methods for conducting surveillance among populations most at riskfor HIV.Public health surveillance for HIV is the systematic, ongoing collection of data on the occurrence, distributionand trends in HIV infection. In general, the objectives of surveillance include: to estimate the magnitude of a health problem in a population at risk to understand the natural history of a disease to evaluate prevention and control activities to monitor changes in trends in the epidemic to detect changes in health practices or risk factors to identify research needs and facilitate research to contribute to the planning process (1).Additional reasons to conduct HIV surveillance among populations most at risk for HIV are: to guide HIV prevention programming at the local level to inform priority-setting and resource allocation at the national level to contribute to the scientific understanding of HIV transmission in populations most at risk for HIVinfection as a result of high-risk behaviour to inform disease burden and treatment needs among most-at-risk populations.When monitoring the HIV epidemic, it is important to identify populations that are most at risk for infection.The sexual and drug-use behaviours of populations contribute to the overall burden of HIV in the country.People with these behaviours are often the first to become infected and are at risk of being infected at ahigher rate than those in the general population.The primary target audience of this guide includes surveillance specialists. In addition, this guide will beuseful for programme managers at national and subnational levels to better understand the strengthsand weaknesses of the data they are using to make decisions. Finally, this guide will also be useful fordonor agencies that support HIV surveillance activities and measure the success of their activities throughsurveillance data.Most countries and their development partners already have some form of HIV surveillance among mostat-riskpopulations. This guide is intended to help refine and standardize their HIV strategies and activitiesfor HIV surveillance among these populations. It presents different approaches along with their advantagesand disadvantages. It is hoped that this guide will empower managers and decision-makers to consideradditional options for strengthening their HIV surveillance systems so that they are able to compare trendsover time.3