WSW is not a risk population used in the Evaluation Guidance. The behavioral risk populations used in the Guidance are not intended to be exhaustive but to represent the majority of cases of transmission. For process monitoring (chapter 4), jurisdictions may report on risk populations that do not fit the categories in the Guidance in a narrative format using the variables indicated on the process monitoring forms in chapter 4 (e.g., gender, race, ethnicity, setting, etc.).

Since the intervention is focusing on MSM, the primary risk population should be coded as MSM. MSM/IDU should be used to code the risk population when the intervention is designed specifically to meet the needs of men who have sex with other men and use injection drugs.

The question to ask for any intervention is, "What is the behavioral risk for HIV that is being addressed?" In the case of an intervention to reduce crack use, the assumption is that the behavioral risk for HIV would be sexual risk associated with crack use, either MSM or heterosexual. If this is the case, then one of these sexual risks would identify the risk population.

Regarding "Mother with/at risk for HIV," the Evaluation Guidance states, "Intervention will address the HIV prevention needs of women who have HIV or are at risk of becoming infected and who are pregnant and, thus, at risk of transmitting HIV to their infant." Therefore, if the pregnant woman is HIV-negative, the risk is for both mother and infant. If the pregnant woman is HIV-positive, the risk is for the infant. The risk population category remains "Mother with/at risk for HIV."

For intervention plans, project numbers for each primary population (risk population such as MSM, IDU). For process monitoring, report the primary population as accurately as possible. Counseling implies that a risk assessment will be completed and this should help inform reporting.

Use the Evaluation Guidance’s broader definition. The risk population category, "heterosexual contact," does include heterosexual contact with multiple partners of unknown risk.

Also, heterosexual risk can include risk to the client as well as risk from the client (e.g., the primary population for an intervention is "heterosexual" because clients have sex with injection drug users; the primary population for an intervention is "heterosexual" because clients are HIV-infected heterosexuals).

The MSM and heterosexual behavioral risk populations defined in the Guidance reference risk; for example, MSM are at risk through unsafe sex; heterosexual men and woman are at risk through unsafe heterosexual sex. It is assumed that a jurisdiction which funds an intervention for MSM has decided that the intervention, in fact, is reaching men likely to be at risk for HIV.

Transgender persons should be counted as clients who receive a particular intervention but they are not a primary or secondary risk population according to the Evaluation Guidance. If their risk for HIV is sexual, the risk population is either heterosexual or MSM depending on their current gender identification. Similarly, crack users is not a primary or secondary population. Their risk for HIV is most likely sexual (either heterosexual or MSM).

The primary and secondary populations are the behavioral risk populations identified in the Guidance. Jurisdictions may collect data on risk populations as the jurisdiction defines those populations separate and apart from CDC’s definitions.

Every effort should be made to estimate a primary and secondary population in situations where an intervention targets both populations (note that data are reported only on primary populations). As a last resort, two populations that cannot be distinguished as "primary" and "secondary" should be reported separately as two primary populations. Because the members of the group cannot be distinguished by risk, the full population should be counted in each primary population report (i.e., they will be double-counted).

A jurisdiction may "split" the population for local reporting, but must be careful to match the specificity of the intervention plan reporting to that of process monitoring; i.e., if the population is split for intervention plan estimation, then it should be split for process monitoring reporting.

With the exception of "Mother with/at risk for HIV" and "General Population," the Guidance uses behavioral risk population categories (i.e., MSM, MSM/IDU, IDU, and heterosexual) because intervention types are used to influence particular risky behaviors that transmit HIV disease. CDC’s strategic plan discusses youth because interventions should be targeted at the risky behaviors youth engage in. Data on youth served should be provided under the age range categories for intervention plans and process monitoring. In a similar vein, the prevention needs of HIV-infected persons are discussed in the strategic plan but HIV-infected persons are not a risk population category in the Guidance. Health departments are encouraged to fund programs that serve youth and HIV-infected persons, but the data to be submitted to CDC should reflect the risk population categories of the Guidance.

Agencies will likely have their own policies on conducting a risk assessment or otherwise determining risk behaviors. Current risk behaviors are most important because interventions will target behaviors clients are currently engaged in.