Reaching Key Populations With HIV Services: A Public Health Priority

March 21, 2014
Volunteers and Health Workers at PEPFAR-Supported Mobile Clinic

In the first ten years of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), we saw amazing success in terms of turning the tide on the HIV/AIDS epidemic.  This success is a direct result of the comprehensive prevention, treatment and care provided by PEPFAR and others, and our joint commitment to following the science in addressing the epidemic.

Yet, getting ahead of the virus is only possible if people can access available services.  With HIV/AIDS, when it comes to serving the public health, we need to reach all affected populations with comprehensive HIV services. And that means going to where the virus is to provide prevention and treatment.   Doing so is vital to a robust, comprehensive, and effective global AIDS response.

Through PEPFAR, the United States has long been a global leader in expanding access to, and uptake of, comprehensive HIV services by key populations.  These include men who have sex with men (MSM), sex workers (SW), and people who inject drugs (PWID).

This is not always an easy task. Stigma, discrimination, and fear of violence or legal sanctions are among the many obstacles that can undermine access to health care, including essential HIV services, by key populations.  Breaking down these barriers is essential to achieving an AIDS-free generation; there is no other way to get there.  That is why the United States, through PEPFAR, is so strongly committed to advancing scientifically-based strategies to reach all affected populations with HIV services.  This commitment is made crystal clear in core policy documents, such as the PEPFAR Blueprint and PEPFAR’s Technical Guidance on Combination HIV Prevention for Men Who Have Sex with Men.

Around the world -- from Africa and Asia, to the United States and the Caribbean – effective HIV/AIDS responses are centered on engaging individuals at risk of acquiring or of onward transmission of HIV; reaching them with appropriate HIV prevention, treatment, and care services; and retaining them in this service continuum over time. And these responses also require that all individuals have equitable access to appropriate and non-discriminatory HIV services, irrespective of sexual orientation or gender identity.

It is no coincidence that in contexts where these core elements are in place, we have seen significant declines in new HIV infections and AIDS-related mortality that, in turn, have accelerated progress toward achieving an AIDS-free generation.  Conversely, in contexts where these core elements are absent or significantly lacking, particularly for key populations, progress against the epidemic has typically either stalled or reversed course.

As it so often does, science has shown us the way.  When we follow the evidence base – and the evidence here is unequivocal that providing proven HIV interventions to those who need them, regardless of race, gender, age, sexual orientation, is most effective -- we are always on solid ground.  Science is the foundation for all PEPFAR programs, and it should be for all efforts everywhere.

During the Obama Administration, PEPFAR has significantly expanded its overall programmatic efforts to increase access to, and update of, HIV services among key populations.  Recognizing the importance of effective programs to engage often marginalized individuals, in the past year alone, PEPFAR has launched a series of special initiatives to direct specific resources toward addressing the HIV-related needs of these populations. 

In May 2013, PEPFAR targeted $20 million in stimulus funds to support increased HIV programming among key populations, improving our ability to reach and engage those at risk of HIV infection.   These funds were matched by $13 million from PEPFAR country budgets, bringing the total new investment to $33 million.  Eight of these grants are specifically focused on addressing HIV/AIDS among MSM.  PEPFAR also provides $2 million in annual funding to the Robert Carr Civil Society Network Fund (RCNF) -- a unique collaboration between donors and civil society that focuses on supporting the HIV needs, and protecting the human rights, of key populations, including LGBT and transgendered persons.

There is no disputing that to reach our collective goal of achieving an AIDS-free generation, HIV services must be driven by science, comprehensive in nature, and delivered in a non-discriminatory manner.  When we follow sound public health and reach people who need services with services, we win.  If we don’t reach marginalized populations with services, the virus wins. It is that simple.

About the Author: Deborah von Zinkernagel serves as the Acting U.S. Global AIDS Coordinator for the U.S. President's Emergency Plan for Aids Relief (PEPFAR).

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