HIV content in the standard DHS Questionnaires
The standard Woman’s and Man’s Questionnaires for The DHS Program include questions to measure HIV-related indicators on knowledge of HIV prevention, discriminatory attitudes, stigma experienced by people living with HIV, high-risk sexual behaviors, condom use, and HIV testing. Questionnaire content in the area of HIV focuses on measuring UNAIDS Global AIDS Monitoring (GAM) Indicators. These standard questions are included in every DHS survey, unless a country requests to remove them. Requests to remove HIV-related questions are not common. Countries may also choose to add HIV-related questions to address their specific data needs.
HIV-related biomarkers are not standard in surveys conducted by The DHS Program. However, they may be added when countries request it, and sufficient funds can be raised for the addition. HIV serology—used to measure the prevalence of HIV infection—is the biomarker requested most often. Additional HIV-related biomarkers, such as viral load and HIV incidence have been measured in a few surveys.
In line with UNAIDS guidelines , The DHS Program recommends careful consideration of the merits of including HIV biomarkers in countries where national prevalence is below 2%. The DHS Program also recommends against including HIV biomarkers in a survey when the country has recently collected or will soon collect HIV biomarkers in another national household survey, such as a Population-based HIV Impact Assessment (PHIA). However, host-country governments determine the content of their DHS surveys and they are not obligated to follow this guidance.
When measurement of HIV prevalence is included in a survey, The DHS Program uses a parallel testing approach. The HIV prevalence estimate is based on blood that is collected in the household and sent to a central laboratory for testing. The laboratory testing is conducted anonymously, and these results cannot be returned to respondents. However, to provide respondents an opportunity to learn their HIV status, surveys also include home-based testing and counseling. The home-based testing uses rapid diagnostic tests in line with the country’s national HIV testing algorithm. Pre- and post-test counseling and the HIV test results are provided to respondents before the survey biomarker technician leaves the household. Individuals who test positive for HIV, and those whose test results are inconclusive, are referred to a healthcare facility for additional testing and linkage to care. Participation is completely voluntary, and respondents may choose to participate in the home-based test only, the laboratory test only, both tests, or neither test.
When HIV testing is included in a DHS survey, it is implemented as a fully integrated part of the survey. Training on home-based testing and counseling and on collection of blood for laboratory testing is incorporated in the training for biomarker technicians along with measurement of height and weight, hemoglobin, and any other biomarkers included in the survey. During implementation of the survey fieldwork, the biomarker technicians conduct home-based counseling and testing for HIV and blood collection for laboratory testing at the same time as they measure the other survey biomarkers.