In the 12 months since the International AIDS Conference followed calls for an AIDS-free generation with a theme of “Turning the Tide Together,” two aspirational guides provided directions for the way forward. First came the PEPFAR Blueprint, Creating an AIDS-free Generation , presented on the eve of the last World AIDS Day by then Secretary of State Hillary Clinton who warned, even as she praised the plan from the world’s biggest AIDS donor: “The history of global health is littered with grand plans that never played out.” The plan was built with some anticipation of the new consolidated World Health Organization Guidelines for treating and preventing HIV infection. Both were based on the understanding that interventions that reach everyone who needs them are exponentially more effective than ones that don’t.
Now amfAR, the Foundation for AIDS Research has released an issue brief, Tackling HIV/AIDS Among Key Populations: Essential to Achieving an AIDS-free Generation, that spells out the importance of reaching four populations at greatest risk of acquiring and transmitting HIV: people involved in commercial sex, people who inject drugs, men who have sex with men, and transgender people. With criminalization, neglect, discrimination, and physical violence confronting these populations, getting an accurate count of their numbers has been a challenge. The brief notes that the prevalence of HIV among these populations has long been underestimated and that recent epidemiological studies have determined that they bear a “major share” of the epidemic worldwide, that doesn’t stop with them. After noting that HIV prevalence is 22 times higher among people who inject drugs than in the general population, that in low and middle income countries, men who have sex with men are 19 times more likely to have HIV and female sex workers more than 13 times more likely than the general population, and that available evidence has shown 19 percent of transgender women in 15 countries are living with HIV, the briefing presents a concise and striking graphic on the proportions of new HIV infections happening among these “key populations” and their sex partners in six countries. But perhaps even more striking are the blank spots on a map from a 2012 Lancet Infectious Diseases article on the Worldwide burden of HIV in transgender women showing how great the absence of knowledge on that population continues to be. Effective interventions for all of these populations are known. That is not the problem, the brief notes. Sustained political will, and priorities to reach the people who need them them is.
In the meantime, the Special Summit of African Union on HIV and AIDS, Tuberculosis and Malaria that met July 12- 16, produced a declaration reiterating a commitment to strong and effective responses to the three diseases, including through poverty elimination strategies, addressing barriers to affordable medicines, integrating sexual and reproductive health and rights services, and a pledge to “review relevant laws and policies at national and regional levels to strengthen rights-based protections for all vulnerable and key populations . . . ”
Finally a joint statement by the Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and Stop AIDS Now, that welcomed the 2013 WHO consolidated HIV treatment guidelines stresses that the role of community-based interventions, involvement of those living with HIV, and protection of human rights will be vital to turning the guidelines into practice.