Six core indicators are proposed that are common to all populations. For most of them, in order to measure current behaviour, the proposed time period of reference is the last 12 months .
1. Number of sexual partners in the last 12 months This indicator allows for construction of UNGASS indicator No 16: percentage of adults aged 15-49 who had sex with more than one sexual partner in the past 12 months.
2. Use of a condom at last intercourse with identification in a consecutive question of the type of partner with whom this last intercourse took place: stable partner, casual partner or paid partner
The first part of the indicator allows for construction of UNGASS indicator No. 17 (also, respectively, No. 18 for sex workers, No. 19 for MSM , and No. 20 for IDU): percentage of adults aged 15-49 who had sex with more than one sexual partner in the past 12 months reporting the use of a condom during their last sexual intercourse.
Most European countries that ask a question on condom use also try to differentiate according to the type of partner. The proposed way of presenting this indicator would allow for compliance with UNGASS requirements without loosing valuable information.
3. HIV test It is proposed that this indicator be constructed with three questions: the first on lifetime experience of the test (having ever been tested), followed by a question on the date of the last test and a question on the result of the test (or the biological result if a biological sample is associated). The last question may only be included in circumstances where the answer can remain anonymous. This allows for construction of UNGASS indicator No. 7 (and also for No. 8 in most-at–risk populations): percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who know their results.
4. Sex work: having paid for sex in the last 12 months and use of condom at last paid sex (in the last 12 months) As little information is collected in sex workers in Europe, it is proposed to have at least one indicator on the sexual behaviour of clients of sex workers, that is, persons reporting having paid for sex, and that this information be collected in each population.
5. Contextual indicators As listed below, three main indicators are proposed that can provide relevant information for surveillance with regard to vulnerability. Two are widely used as socio-demographic variables.
- Level of education: this allows for exploration of social inequalities regarding HIV/STI. It is proposed that the International Standard Classification of Education (ISCED) system be used.
- Nationality/ethnic origin. These indicators have relevance for social integration and mobility and are frequently used. In the expert discussion during the Behavioural Surveillance Expert Meeting in Montreux, they were seen as important, but the view was expressed that no commonly agreed satisfactory indicator is currently available, and more research is needed.
- Sexual orientation: it is proposed that a modified Kinsey classification, using 5 items, be adopted, as is currently the case in several countries in Europe).
6. Composite indicator of HIV knowledge (UNGASS indicator No. 13): the experts convened for the Behavioural Surveillance Expert Meeting in Montreux acknowledged the usefulness of having an indicator on knowledge, but also felt that the content and wording of the questions included in this composite indicator would need to vary according to the context. State of knowledge varies over different countries and populations and over time, and the precise questions asked would need to reflect this in order to be able to monitor change. On this point, more research is therefore needed and the existing UNGASS indicator cannot be proposed with the same level of agreement (indicator not in grey in the table). The existing corresponding UNGASS indicator is No. 13 (also, No. 14 with regard to “most-at-risk populations”): percentage of young women and men aged 15-24 who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission.
As this indicator only measures HIV-related knowledge, a similar indicator capturing STI-related knowledge should also be developed.
The indicators 5 and 6 are not included in the tables.