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HIV prevalence measurement in household surveys: is awareness of HIV status complicating the gold standard?

Since the introduction of HIV serological testing in Demographic and Health Surveys (DHS) in 2001, national serosurveys have become the gold standard of HIV prevalence estimation in countries with generalized epidemics [1]. By June 2012, 48 DHS or AIDS Indicator Surveys (AIS) in 33 countries (of which 28 are in Africa, 26 with generalized HIV epidemics) have included HIV serotesting of adult men and women, which is anonymous, informed and voluntary [2,3]. These nationally representative surveys use standardized sampling, questionnaires and testing protocols to produce data that are comparable over time and among countries.