The Demographic and Health Surveys (DHS) project, implemented by Macro International, Inc., has been conducting surveys in Africa, Asia, Latin America, and Eastern Europe since 1984. The project has earned a worldwide reputation for collecting and disseminating nationally representative data on various health and demographic indicators, including HIV/AIDS. The DHS project is funded by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), with additional funding from national governments, multilateral, and bilateral donors.
The DHS project has improved the way the world measures HIV prevalence. Prior to 2001, HIV prevalence was estimated largely from sentinel surveillance that monitored HIV rates in pregnant women attending antenatal care. In 2001, DHS included testing for HIV in the Mali Demographic and Health Survey, providing the first HIV prevalence estimates from a nationally representative, population-based sample. This approach allows for the inclusion of men, nonpregnant women, and those without access to health facilities, providing a representative sample of a national population.
Between 2001 and 2008, DHS included population-based HIV testing as part of 28 surveys in 28 countries, resulting in revised HIV estimates for these countries and a new understanding of the global HIV epidemic. The DHS project has tested over 400,000 women and men worldwide, with sample sizes ranging from 1,675 in Hai Phong Province, Vietnam, to over 102,000 in India. The testing protocol involves informed, anonymous, and voluntary testing of women and men interviewed, with a laboratory protocol that includes an initial ELISA test, retesting of all positive tests, and a second ELISA test for 5 to 10 percent of the negative tests.
The HIV prevalence rates are highest in the countries surveyed in Southern Africa, with more than 15% of women and men age 15-49 infected with HIV in four countries (Lesotho, Swaziland, Zambia, and Zimbabwe). East Africa has more moderate rates of HIV infection, ranging from 1.4% in Ethiopia to 7.0% in Tanzania. The highest HIV prevalence rates are found in the Caribbean, with rates ranging from 11.8% in Haiti to 23.5% in the Dominican Republic.
The DHS project has provided a wealth of information on HIV prevalence and has helped to improve understanding of the HIV pandemic. The data collected through the DHS project have been used to inform national and international policies and programs aimed at reducing the spread of HIV/AIDS. The project has also provided a framework for monitoring and evaluating the effectiveness of these programs.
The DHS project has also provided data on the sociodemographic and behavioral factors associated with HIV infection, such as age, education, residence, marital status, and higher-risk sexual behaviors. This information has been used to develop targeted interventions aimed at reducing the spread of HIV/AIDS among vulnerable populations.
The DHS project has been instrumental in improving the understanding of the HIV pandemic and has provided a framework for monitoring and evaluating the effectiveness of programs aimed at reducing the spread of HIV/AIDS. The project has also provided a wealth of information on HIV prevalence and has helped to inform national and international policies and programs aimed at reducing the spread of HIV/AIDS.