Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic?

OBJECTIVE: The objective of this paper was to analyse the quality of HIV/AIDS sentinel surveillance systems in countries and the resulting quality of the data used to make estimates of HIV/AIDS prevalence and mortality. METHODS: Available data on sero-surveillance of HIV/AIDS in countries were compiled in the process of making the end of 1999 estimates of HIV/AIDS. These data came primarily from the HIV/AIDS Surveillance Database developed by the United States Census Bureau, from a database maintained by the European Centre for the Epidemiological Monitoring of AIDS and all country reports on sentinel surveillance that had been provided to World Health Organization or UNAIDS. Procedures were developed to score quality of surveillance systems based on four dimensions of quality: timeliness and frequency; appropriateness of groups; consistency of sites over time; and coverage provided by the system. In total, the surveillance systems from 167 countries were analysed. RESULTS: Forty-seven of the 167 countries whose surveillance systems were rated were judged to have fully implemented sentinel surveillance systems; 51 were judged to have systems that had some or most aspects of a good HIV surveillance system in place and 69 were rated as having poorly functioning or non-existent surveillance systems. CONCLUSION: This analysis suggests that the quality of HIV surveillance varies considerably. The majority of countries most affected by HIV/AIDS have systems that are providing sufficient sero-prevalence data for tracking the epidemic and making reasonable estimates of HIV prevalence. However, many countries have poor systems and strengthening these is an urgent priority.

Where "being married" may be the greatest risk factor for acquiring HIV. Country focus: Ghana.

PIP: HIV/AIDS is endemic in Ghana, with equal proportions of men and women infected. The situation is worsening and prevention and control measures must be intensified. Young people have the highest rate of HIV infection; the highest prevalence among pregnant women is consistently found among 20-24 year olds. Female school dropouts and girls who have never been to school are at particular risk. Surveys indicate that many such women lack knowledge about HIV/AIDS and other sexually transmitted diseases (STD), fail to practice safer sex, and do not have adequate access to health care. Many exchange sex for cash and other substantive offerings. Current education and prevention messages, however, are not enough to induce people to practice safe sex. Women may want to protect themselves against HIV infection, but be in no position to do so. For example, it is socially acceptable for the husbands of married women to have other sex partners. Should the man contract HIV from his extramarital partners, his wife will be at considerable risk; wives in Ghanaian society typically do not have enough power to demand safe sex with their husbands. Many other women must prostitute themselves to survive in the country's widespread poverty. The underlying social and economic factors which put women at risk for contracting and transmitting HIV must be addressed.^ieng