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WHO Report: High-Risk HIV Groups Threaten AIDS Progress

People most at risk are least likely to receive care

Failure to provide adequate human immunodeficiency virus (HIV) services for key groups — men who have sex with men (MSMs), people in prison, people who inject drugs, sex workers, and transgender people — threatens global progress on the response to HIV, the World Health Organization (WHO) warns.

These groups are most at risk of HIV infection and yet are least likely to have access to HIV prevention, testing, and treatment services, WHO says. In many countries they are left out of national HIV plans, and discriminatory laws and policies are major barriers to access.

WHO has issued new guidelines on HIV prevention, diagnosis, treatment, and care for the five “key populations” in the lead-up to the International AIDS Conference in Melbourne, Australia, starting July 20.

For the first time, WHO strongly recommends that MSMs consider taking antiretroviral drugs as an additional method of preventing HIV infection (pre-exposure prophylaxis), along with the use of condoms. Rates of HIV infection among MSMs remain high almost everywhere, and new prevention options are urgently needed, WHO says.

The guidelines were published as new data underscore the need for continued global progress on controlling HIV infection. By the end of 2013, approximately 13 million people were taking antiretroviral therapy (ART), with 11.7 million of these people living in low- and middle-income countries. This led to a 20% drop in HIV-related deaths between 2009 and 2012.

However, there are still significant gaps in addressing the needs of the key populations in national HIV plans, WHO says. Globally, only 70% of countries surveyed explicitly address the needs of MSMs and sex workers, while the figure for injecting drug users was 40%. Transgender people are rarely mentioned in HIV plans.

Key populations are less likely to have equal access to HIV treatment. For example, in some settings in Eastern Europe, people who inject drugs make up more than half of all people living with HIV, but only one-third of people living with HIV have access to lifesaving ART.

“Bold policies can deliver bold results,” said Dr. Rachel Baggaley of the WHO’s HIV Department. “Thailand was one of the first pioneers of programs to recognize the need to keep sex workers healthy and to reduce new HIV infection. Malaysia, Spain, and the United Republic of Tanzania have made major advances in providing opioid substitution therapy and needle-and- syringe programs for people who inject drugs. Data show that where a combination of effective HIV prevention and treatment services for people who inject drugs is available, HIV transmission among people who inject drugs is minimal.”

The WHO’s new guidelines outline “comprehensive HIV packages” for prevention, diagnosis, treatment, and care in the five key populations and address specific issues and needs of adolescents from these groups. The guidelines also include measures to better manage sexual and reproductive health, mental health, and co-infections, such as tuberculosis and hepatitis. In addition, they highlight the need for needle-and-syringe and opioid-substitution therapy programs and include recommendations for the treatment of overdose in the community.

Source: WHO; July 11, 2014.

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