Objective  To explore an optimal alternative index of population viral load (PVL) suitable for assessing potential human immunodeficiency virus (HIV) transmission in the population of Yining city, Xinjiang Uygur Autonomous Region.

  Methods   All previously and newly diagnosed HIV/AIDS cases aged ≥ 13 years were recruited into a dynamic cohort in Yining city from 2017 through 2019. Questionnaire interviews and viral load (VL) monitoring were conducted among all the HIV/AIDS cases. Based on the data collected, PVL, monitored viral load (MVL), in-care viral load (ICVL), aware viral load (AVL), and community viral load (CVL) were calculated and viremia prevalence, HIV infection incidence, antiretroviral therapy (ART) coverage, and viral inhibition rate were estimated. Correlations among the indicators were assessed.

  Results  All values of PVL, MVL, ICVL, and AVL decreased significantly during the 3-year period (all P < 0.05). The decrease in CVL were significantly correlated with the increase in HIV infection incidence (r = 0.999, P = 0.028). The CVL is inversely correlated with ART coverage (r = – 1.000, P = 0.001) and virus inhibition rate (r = – 1.000, P = 0.010). The viremia prevalence rates with specific VL cut-off values were significantly correlated positively with HIV infection incidence (for VL > 400 copies/m: r = 0.997, P = 0.048 and for VL > 1 000 copies/mL: r = 0.998, P = 0.041) but inversely with ART coverage (r = – 1.000, P = 0.019 and r = – 1.000, P = 0.012) and virus suppression rate (r = – 1.000, P = 0.010 and r = – 1.000, P = 0.003).

  Conclusion  CVL is the most optimal alternative index of PVL and could be adopted together with viremia prevalence rate in assessment on potential HIV transmission intensity.