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Defining rights-based indicators for HIV epidemic transition

2018; Public Library of Science; Volume: 15; Issue: 12 Linguagem: Inglês

10.1371/journal.pmed.1002720

1549-1676

Joseph J Amon, Patrick Eba, Laurel Sprague, Olive Edwards, Chris Beyrer,

Sex work and related issues

In 1971, Omran described a sweeping theory of epidemic transition: as countries become wealthier, modernization and socioeconomic progress drive down high rates of mortality due to infectious diseases while noncommunicable disease (NCD) burdens increase [1].Although the theory was initially met with support, the spread of HIV in high-income countries and the growing burden of NCDs in low-and middle-income countries, along with the recognition of health inequities in both settings, raised doubts about the validity of a single, generalizable theory of epidemic transition. Summary points• Stark differences in HIV incidence and mortality across locations and populations demonstrate the challenge of identifying a single indicator, at national scale, of progress toward the control of HIV epidemics.• Even in countries that report decreases in HIV incidence, incidence may be increasing among groups that are particularly vulnerable and face political and social exclusion, especially sex workers, people who inject drugs, transgender persons, men who have sex with men, and prisoners.• To comprehensively evaluate national progress on HIV, five categories of indicators should be examined that address: levels of coverage of key evidence-based prevention and treatment interventions; incidence and prevalence of HIV infection; AIDS-related or all-cause mortality among people living with HIV; stigma and discrimination; and the legal and policy environment.• Indicators should be disaggregated, whenever feasible, to fully reflect progress and challenges relating to all populations and locations in the national response.• The process of evaluating indicators of national progress should meaningfully involve people living with HIV and from key populations as an important part of data validation.