AIDS 2014: WHO prevention strategies to focus on key populations
The World Health Organisation (WHO) has released a comprehensive guideline updating its strategies and focus for key populations. The guidelines, released earlier this month, suggest failure to provide adequate services for key groups threatens the global response to ending HIV.
Assistant Director General Hiroki Nakatani said the update on new numbers of those living with the virus showed prevention in key populations was critical and WHO wanted to assure no one was left behind.
Natakatani said global updates on where we are with treatment have been encouraging but progress with key populations had been patchy, saying access to treatment and care among key populations was a challenge.
Gottfried Himschall, the director of the HIV department, WHO, described the WHO guidelines as a landmark report. He said the documents speak to the health sector’s response, where major progress has been made specifically in the area of treatment, thanks to better access.
Himschall said however the report highlights the unevenness of the progress – with certain countries falling behind in the effort to stamp out transmission of the virus.
Key populations such as msm, transgender people, sex workers, injecting drug users and persons in prison also have compromised access to service,” Hirmschall said.
With trans people with an incident 50 times higher than the general population and MSM 13 times higher, Himschall said it was essential these key groups were not left behind. To assist governments in providing services and access to treatment to the groups most affected by the virus, Himschall said the guidelines must be used to help inform major policies to eliminate discrimination and provide enabling environments.
”Unless global communities put emphasis on addressing this imbalance our vision of ending the epidemic of HV by 2030 will not happen,”Himschall said.
Rachel Baggaley – the coordinator of the Key Populations and Prevention HIV Department WHO, highlighted the collaborative process of the documentation saying WHO sought extensive community involvement speaking with stakeholders and key populations to find the areas in which services were failing.
She said the guidelines were meant to give countries what they “need to provide acceptable and effective services for key populations”.
She said with UNAIDs estimating half of all new infections were in key populations it was essential governments adopt new measures to enable easier access to treatment and prevention.
"It’s critical for health services to offer treatment in an enabling environment so more people from key populations can access services. We’ve worked on case studies to provide services for key populations even in legally constrained settings,” Baggaley said.
IAS President-elect – Chris Beyrer described the guidelines as a "living document" and also discussed the use of PrEP as a prevention option. Beyrer highlighted that PrEP be considered as an option amongst a comprehensive package of services, including traditional prevention methods such as condoms.
He also suggested previous media response which seemed to indicate WHO was recommending PrEP for all gay men were unfounded, saying it was a matter of choice.
“Think about contraception and family planning,” he said. “We offer multiple choices - we don’t say all women who don’t want to get pregnant should go on the pill, or should used condoms. Everyone has a choice and those choices may change over the course of a lifetime; they may choose pill then an IUD or tubal ligation, in later years.
“It is really for men to consider when they are sexually active and at risk of HIV exposure.
"Currently there are not prep recommendations for other key populations - but rather a call for more demonstration projects for people like transgender women and sex workers for whose operational issues make PrEP something that should be explored through community consultation.”
Beyrer said barriers to service are what drives an epidemic and said the guidelines are critical to people demanding access and better health services.
“It has put human rights as a principle and it makes a strong case to government and donors to reducing barriers to treatment,” Beyrer concluded.
Dr Phillip Read from Sydney’s Kirketon Road Centre applauded the guidelines recommendations on the use of naloxone to people who are in danger of overdosing.
”We know that 60 percent of overdoses occur in the presence of others and the time to someone responding is critical to saving lives,” said Read. This will reduce the morbidity of overdose.”
He was also delighted by the decision to promote continued and expanded access to needle and syringe programs and sighted Australia’s success with needle exchange services.
“It cant be overstated, a comprehensive needle and syringe program works. Less than 1 percent of infections cross the country [are from needles]. There are. 21 people across Australia in the past year.”
Finally Fabio Mequita from the HIV and Viral Hepatitis Programme at the Ministry of Health in Brazil said: “ We must focus on key populations or we have no future in controlling the epidemic."