Know Your Epidemic & Modes of Transmission

To strengthen national efforts countries are being encouraged to ‘know your epidemic’ by identifying the behaviours and social conditions that are most associated with HIV transmission, that undermine the ability of those most vulnerable to HIV infection to access and use HIV information and services. Knowing your epidemic provides the basis for countries to ‘know your response’, by recognizing the organizations and communities that are, or could be, contributing to the response, and by critically assessing the extent to which the existing response is meeting the needs of those most vulnerable to HIV infection.

We must to encourage countries to know their epidemic because we have learned over the last twenty-five years that the epidemic keeps evolving. It is important for countries to take stock of where, among whom and why new HIV infections are occurring. Understanding this enables countries to review, plan, match and prioritise their national responses to meet these needs.

The Analysis of Prevention Response and Modes of Transmission Study (MOT) is a multi-country initiative currently supported by UNAIDS and the World Bank Global HIV and AIDS Programme's Global HIV/AIDS Monitoring and Evaluation Team (GAMET).

Through the MOT initiative, technical teams led by the National AIDS Councils in 5 countries in East and Southern Africa (Kenya, Lesotho, Mozambique, Swaziland and Uganda) have developed a detailed synthesis report that describes their epidemics, presents their expected distribution of new HIV infections over the next 12 months, examines the adequacy and gaps in their current prevention response and resource allocation for prevention and makes recommendations for the national prevention strategy based on this evidence.

Synthesis reports

Synthesis reports are the final products of the MOT study. These reports present and discuss the findings from the various MOT study components in order to assess the extent to which strategic HIV prevention priorities and resource allocation reflects geographic contexts of elevated risk; assess the extent to which strategic HIV prevention priorities and resource allocation address the major discrete transmission patterns and vulnerable populations and make recommendations to enhance strategic prevention prioritization and resource allocation.

Kenya

This study synthesizes existing and new data to characterize Kenya's HIV epidemic, and briefly reviews the prevention response and funding. It assesses how well prevention aligns with evidence on sources of new infections. (This is part of a program of work led by the UNAIDS Regional Support Team for Eastern and Southern Africa, with support from UNAIDS Geneva and the Bank's Global HIV/AIDS Program)

Swaziland

This study synthesizes existing and new data to characterize Swaziland's HIV epidemic, and briefly review the prevention response and funding allocation (drawing on the 2008 National AIDS Spending Assessment). It assesses how well prevention aligns with evidence on sources of new infections. Recommendations to enhance the effectiveness of prevention are offered. The data confirm the hypothesis that multiple, concurrent long-term heterosexual relationships, in a context of implicitly permissive social norms, gender inequality and economic need, are a key contributor to HIV transmission in Swaziland. (This is part of a program of work led by the UNAIDS Regional Support Team for Eastern and Southern Africa, with support from UNAIDS Geneva and the Bank's Global HIV/AIDS Program).

Lesotho

This study synthesizes existing and new data to characterize Lesotho's HIV epidemic, and briefly reviews the prevention response and funding. It assesses how well prevention aligns with evidence on sources of new infections. (This is part of a program of work led by the UNAIDS Regional Support Team for Eastern and Southern Africa, with support from UNAIDS Geneva and the Bank's Global HIV/AIDS Program).

Uganda

This study synthesizes existing and new data to characterize Uganda's HIV epidemic, and briefly reviews the prevention response and funding. It assesses how well prevention efforts align with evidence on sources of new infections, and identifies how the emphasis and targeting of prevention could be shifted to where most new infections are occurring. The greatest need for HIV prevention exists among people with multiple partners whether in casual or long-term martial or cohabiting relationships. Also, HIV prevention programmes for sex workers and their clients, fishing communities and other groups with high prevalence/incidence rates are poorly funded. (This is part of a program of work led by the UNAIDS Regional Support Team for Eastern and Southern Africa, with support from UNAIDS Geneva and the Bank's Global HIV/AIDS Program).

Articles and abstracts

M. Colvin, M. Gorgens-Albino, S. Kasedde
Analysis of HIV prevention responses and modes of HIV transmission: the UNAIDS-GAMET- supported synthesis process. 2008

Tools for analysis