In sub-Saharan Africa, where 61% of all new HIV infections occur, women are disproportionally affected by HIV, accounting for 54% of all new HIV infections in 2018. Young women aged 15–24 years were the hardest hit, accounting for 25% of new HIV infections in the region but representing only 10% of the total population.

Outside of sub-Saharan Africa, however, the situation is different, with men aged 25–49 years accounting for almost half of all new HIV infections, although they represent only 18% of the total population.

While important progress has been made against the global incidence–prevalence ratio—which, while declining from 11.2% in 2000 to 6.6% in 2010 and to 4.6% in 2018, still leaves the world not on track to end AIDS as a public health threat by 2030—the progress is uneven across regions.

Western and central Europe and North America, where treatment coverage is generally high and a comprehensive set of HIV prevention options is available to a large percentage of people at risk of HIV, had an incidence–prevalence ratio of 3.1% in 2018. Performance in other regions ranged from 3.9% in eastern and southern Africa, 4.6% in the Caribbean, 5.4% in both Latin America and Asia and the Pacific, 5.5% in western and central Africa, 8.0% in the Middle East and North Africa and 9.0% in eastern Europe and central Asia.

Recent trends in new HIV infections and AIDS-related mortality can only show part of the story of the AIDS response. Epidemic transition metrics have been developed by UNAIDS and its partners as measures that countries can use to better track their progress towards ending AIDS as a public health threat.

One such metric, the incidence–prevalence ratio, uses the number of new HIV infections and the number of people living with HIV within a population. An epidemic transition benchmark of 3.0%—three HIV infections per 100 people living with HIV per year—corresponds to an average life expectancy after infection of 30 years. At this average life expectancy, the total population of people living with HIV will gradually fall if the country is below the 3% benchmark. The 3.0% benchmark thus combines two desirable conditions: long, healthy lives among people living with HIV and reductions in new infections.

The global incidence–prevalence ratio has declined from 11.2% in 2000 to 6.6% in 2010 to 4.6% in 2018, showing that important progress has been made against the HIV epidemic. Despite this, the world is not yet on track to end AIDS as a public health threat by 2030.

For six weeks, two teams covered 12 HIV clinics on a data checking mission in Papua New Guinea. UNAIDS joined the country’s strategic information technical working group in the National Capital District, which includes Port Moresby, to inspect the clinics’ records to see if they match the records of the National Department of Health.

“The data quality assessment is part of the country’s HIV monitoring and evaluation plan to ensure the quality of data and reporting of the AIDS response,” explained Zimmbodilion Mosende, UNAIDS Papua New Guinea Strategic Information Adviser.

Led by USAID, the two teams of 12 branched out into smaller teams to look at the number of people registered as enrolled on antiretroviral therapy, the number of people newly starting treatment, the percentage of people returning for refills and the number of people who did not return to the clinics. In addition, the groups checked information on, for example, the age and sex of each person.

The volunteers from civil society groups, international nongovernmental organizations, development partners and key government offices went through the records of nearly 5000 people.

Papua New Guinea has the highest HIV incidence and prevalence in the Pacific region. The country of 8.4 million people represents 95% of the reported HIV cases in the region. There are approximately 45 000 people living with HIV in the country, of whom 65% are on antiretroviral therapy.

The groups tried to find out if there are discrepancies in the data and the reasons behind them. Albert Arija, Monitoring and Evaluation Specialist of USAID, described the reasons for discrepancies, which range from there being an inadequate number of staff, hence not enough time to fill out all entries, to incorrect data entry or at times misinterpretation of information. For fear of stigma and discrimination, some clients don’t want to give personal information.

One key missing data point was also birthdates. “Many people in Papua New Guinea cannot recall their exact date of birth,” said Mr Arija.

The technical working group is advocating for the use of electronic forms and real-time reporting. “Since the current antiretroviral therapy forms are still paper-based, there are several potential data quality risks, including human errors, from the data entry and processing,” Mr Mosende said.

Overall, most of the clinics had good quality data and processing, according to the teams’ assessment. They hope to simplify the overall process to scale up the data check for the whole country.