Background

Methods

Overview

The HIV Policy Lab includes a dataset, index, reference library and research/accountability platform that rigorously tracks HIV-related law and policy in 194 countries. The dataset quantitatively represents the HIV-related law and policy environment in a given country for multiple years, enabling governments, civil society, funding agencies and researchers to compare countries.

We draw on methods from policy surveillance—the systematic, scientific collection and analysis of laws of public health significance over time12 —and from comparative political and social science. A variety of qualitative methods are deployed in constructing the dataset including development of coding rules, comparative legal interpretation, and policy and content analysis.345

Currently HIV Policy Lab tracks 33 key areas of HIV-related law and policy across 194 countries over multiple years. Sixteen of these policies are comprised of two or more sub-policies, for a total of 50 policies being tracked. Policies are benchmarked against global norms from WHO and other international bodies and classified accordingly.

The full methodology is described below and more fully in our article “Understanding and Comparing HIV-Related Law & Policy Environments: Cross-National Data and Accountability for the Global AIDS Response” in BMJ Global Health.

A full list of scoring criteria for each policy is available from the HIV Policy Lab codebook (available for download here). In addition, as a companion to the downloadable dataset, a data dictionary that describes all data elements is available on the Data page of the website.

The designations employed and the presentation of the material on this website do not imply the expression of any opinion whatsoever concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. This database aims to be as complete and up-to-date as possible, but is meant for research purposes. It does not reflect legal advice or authority, and is not distributed with a warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall Georgetown University, UNAIDS, or any partner in the HIV Policy Lab be liable for damages arising from its use.

Selection of Indicators

HIV Policy Lab indicators were chosen after an extensive year-long global process that included review of international normative guidance and agreements along with a series of subject-specific, cross-sectoral focus groups and consultations with national policymakers, clinicians, researchers in social and biomedical science, international organizations, financing agencies, communities of people living with HIV, and other civil society groups. Based on those consultations, indicators were identified that would be valid and meaningful to end users, sensitive to the underlying phenomenon being measured, easily interpretable, and to allow for international comparison and consistency over time.6 A condensed set of 33 specific indicators of the HIV policy environment were chosen and grouped according to four categories: treatment, testing and prevention, structural barriers, and health systems factors. The HIV-related policy environment is made up of hundreds of specific policies—those chosen are intended as indicators representing this broader policy context. For each of the indicators, a coding schema was developed to translate information about the content of the laws and policies into data.

Data Collection & Architecture

Each observation in the HIV Policy Lab database represents the policy corresponding to an indicator for a country in a given year. The sources for every observation are publicly available and cited on the pop-up windows on each country page by clicking on the specific indicator. We gather this data on national policies via three distinct approaches.

We collect a large number of primary sources and code the text of laws and policies according to the HIV Policy Lab coding schema. We employ a dual coder strategy and test for intercoder reliability, using native speakers as the primary coder for the majority of texts. These are available in our reference library, which you can help us update.

Data also comes from formal reporting by governments to UNAIDS and the World Health Organization through the Global AIDS Monitoring framework.7 Information about policies is reported through the National Commitments and Policy Instrument (NCPI) and validated by UNAIDS and WHO.

In addition, we conducted a meta-analysis of other published sources of information about policies in the public sphere including United Nations, NGO, and academic sources. A full list of sources is here. These include authoritative data sources recommended and validated by experts in their specific issue areas.

Finally, we fielded an expert survey to collect information on the five of the original 33 policy indicators that did not have existing data to build on. These indicators, and the content of the survey, were on migrant access to care, UHC, user fees, unique identifiers with data protections, and data sharing. Experts across international organizations, civil society, clinical settings, donor organizations, and government institutions were surveyed. By collecting and coding data from multiple sources we are able to triangulate information, include the most up-to-date data available, and allow for a broader scope of analysis.

A custom data architecture with corresponding ontology and taxonomy was developed to capture these data and support integration, comparison to the international norm identified for each topic (typically WHO guidance for each year), and analysis with longitudinal epidemiological data. All data sources are documented on the site, including update frequency. Data are available as download directly from the site or by contacting the research team.

Coding, Scoring, & Benchmarking Against Global Norms

Coding Individual Policies

For each indicator we developed a coding question and coding rule about the content of a country’s policies—intended to provide a specific, measurable indicator for which cross-national data could be collected. A full code book is available here. Each policy indicator is scored on a binary scale 0 or 1, with some questions allowing for an “partial” code of 0.5. This “partial” score is use for two-part indicators or where a question has a logical partial answer. For example, when coding whether national policy allowed for same-day initiation of HIV treatment the options were no (0) or yes (1). The PrEP indicator, meanwhile, includes both whether an antiretroviral has been approved for use and whether those at substantial risk are eligible—with a partial score given if only one of the sub indicators is yes (1). When a sub-indicator has no data (or was not scored), then that sub-component is not included in assessing the score; only the sub-indicators for which there are data are included.

Our focus is on the content of the law and policy in a country—not on how or to what degree that policy has been implemented. In other words we are asking what the rule is, not how that rule is being enforced in everyday life. Policy itself matters—it is the starting point for how governments take what they think works to scale. And we find remarkable differences between countries in the policies they have passed. Recognizing that both policy and implementation matter, we consider it important to separate them—to understand whether what needs to change (or what is working well) is the policy itself or the way it is being used. In focusing on the policy as written or passed down we are able to create comparable data and to help identify where in the policy process attention should be focused—at the rulemaking, interpretation, or implementation stages.8

Benchmarks for Adoption

Each policy is benchmarked against international normative instruments to enable us to interpret our code based on whether a policy is “adopted.” These benchmarks include guidance from UNAIDS, the World Health Organization, and international rights agreements. For example, in tracing policies on when to start antiretroviral treatment we coded the policies of countries and compared the country’s policy against WHO guidance,9 while on issues of criminalization we drew on the international recommendation of the Global Commission on HIV and the Law.10 A full set of benchmarks is available in the full PDF download of the codebook.

Scoring Alignment with Global Norms

For each policy category and overall, each country receives a HIV Policy Lab summary score. For all indicators for which there are data, the total of adopted (1) and partially adopted (0.5) is divided by the total number of indicators scored, then multiplied by 100 to create the continuous score. Where data are missing for a given indicator, the numerator is reduced so that we are only scoring a country based on existing data. Only countries that had data collected on at least one third of all indicators for the policy category and for the overall score are included.

On the website, this scoring metric is reflected in a qualitative sentiment based on the quantitative score to convey the degree to which countries policies are aligned with global norms. The scoring metric is defined by 5 discrete benchmarks: ‘Very Few’ indicates less than 20% policy adoption rate; ‘Few’ is 20-39%; ‘Some’ is 40-59%; ‘Many’ is 60-79% adoption rate; and ‘Most’ indicates that 80% or more policies have been adopted. This same scale is used for policy categories and for country overall policy score.

1

Burris S, Hitchcock L, Ibrahim J, Penn M, Ramanathan T. Policy Surveillance: A Vital Public Health Practice Comes of Age. Journal of Health Politics, Policy and Law 2016;41:1151–73.

2

Kavanagh M, Meier B, Pillinger M, Huffstetler H, Burris S. Global Policy Surveillance: Creating and Using Comparative National Data on Health Law and Policy. American Journal of Public Health; forthcoming.

3

Melton J, Elkins Z, Ginsburg T, Leetaru K. On the Interpretability of Law: Lessons from the Decoding of National Constitutions. British Journal of Political Science 2013;43:399–423.

4

Prior L. Content Analysis. The Oxford Handbook of Qualitative Research 2014;:359–79.

5

Nelken D. Comparative Legal Research and Legal Culture: Facts, Approaches, and Values. Annual Review of Law and Social Science 2016;12:45–62.

6

Brown D. Good practice guidelines for indicator development and reporting. In: Third World Forum on Statistics: knowledge and policy. Busan, Korea: 2009. 27–30.

7

UNAIDS. Global AIDS Monitoring 2020 — Indicators for monitoring the 2016 Political Declaration on Ending AIDS. 2019. https://www.unaids.org/en/resources/documents/2019/Global-AIDS-Monitoring (accessed 18 Jul 2020).

8

Sabatier PA, Weible C. Theories of the policy process. Westview Press 2014.

9

World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. 2nd Ed. Geneva: : WHO 2016.

10

Global Commission on HIV and the Law. Report: Risks, Rights & Health. 2012. http://www.hivlawcommission.org/index.php/report (accessed 28 May 2013).