Increased Targeting of Key Populations Can Accelerate End of
Global HIV Epidemic New Studies Show Potential Impact of
Programs for Sex Workers, People Who Inject Drugs, and Men
Who Have Sex with Men WASHINGTON, November 28, 2012  As
the world prepares to commemorate World AIDS Day on December
1, two new World Bank studies urge governments and their
development partners to provide better prevention, care, and
treatment services for sex workers and people who inject
drugs as an important step toward ensuring a world free of
AIDS. The studies are the second and third in a three-part
series on key populations at higher risk in low- and
middle-income countries. In June 2011, the World Bank and
partners launched the first study, which focused on men who
have sex with men. In many countries, sex workers, people
who inject drugs, and men who have sex with men remain
marginalized in society and vulnerable to HIV, said David
Wilson, World Bank Global AIDS Program Director. Even in
countries with epidemics in the general population, these
groups are disproportionately affected by the epidemic.
Effective interventions not only protect members of these
marginalized communities, but also make a major contribution
to averting a wider epidemic. Sex workers, people who
inject drugs, and men who have sex with men are at
significantly higher risk of HIV infection than other groups
in low- and middle-income countries. According to a recently
released UNAIDS report, among countries with generalized
epidemics, HIV prevalence is consistently higher among sex
workers in the capital city than in the general population,
at around 23%. Around 3 million of the 16 million people
worldwide who use drugs are living with HIV. HIV infection
among men who have sex with men in capital cities is on
average 13 times higher than in the general population. The
World Bank, United Nations Population Fund (UNFPA), and
Johns Hopkins Bloomberg School of Public Health collaborated
on the sex workers study, The Global HIV Epidemics among Sex
Workers, which found that a community empowerment approach
to HIV prevention, treatment, and care is cost-effective,
with significant projected impact on HIV incidence among sex
workers and transmission beyond the sex worker community.
According to the study, globally, HIV disproportionately
affected sex workers in low- and middle-income countries.
The overall HIV prevalence among female sex workers was
11.8%, with the prevalence in Sub-Saharan Africa at 36.9%.
Across all regions, prevalence among female sex workers was
13.5 times the overall HIV prevalence among the general
population of women ages 15-49. Sex workers continue to face
heightened social and structural vulnerabilities to HIV. The
study emphasizes the central importance of adopting a
rights-affirming, empowerment-based approach to scale up
comprehensive HIV services, and addressing stigma,
discrimination, and violence against sex workers. The
World Bank, Futures Group, and Johns Hopkins Bloomberg
School of Public Health study,The Global HIV Epidemics among
People Who Inject Drugs, found that although HIV prevalence
was significantly higher among people who inject drugs than
in the general adult population, the availability of
antiretroviral treatment and other key prevention
interventions was generally inadequate. The researchers
predicted that continuing to specifically target these
groups with needle and syringe programs, medically assisted
therapy and HIV counseling and testing, as well as increased
access to antiretroviral treatment, could avert thousands of
infections from 2012-2015, including 1,300 in Kenya, 4,130
in Pakistan, 1,570 in Thailand, and 3,900 in Ukraine.
Interventions for people who inject drugs are cost-effective
or highly cost-effective investment choices across the
breadth of the global epidemic. The ability to rapidly and
cost-effectively intervene in HIV transmission with
currently proven interventions holds the most promise among
people who inject drugs worldwide, said Farley R. Cleghorn,
MD, MPH, Futures Chief Technical Officer and Team Leader for
the study. The study, Global HIV Epidemics Among Men Who
Have Sex with Men: Epidemiology, Prevention, Access to Care
and Human Rights, found that achieving high rates of
coverage of HIV prevention and treatment services among men
who have sex with men had a significant positive impact on
the overall trajectory of a countrys HIV epidemic. Fewer
than one in ten men who have sex with men worldwide has
access to basic HIV/AIDS prevention, care, and treatment
services. The authors of that study recommended a
comprehensive package of essential services, including
risk-reduction counseling, distribution of condoms and other
safe-sex measures, community-based prevention efforts, HIV
testing, and increased use of antiretroviral therapy
treatment. The report highlights the need for the
decriminalization of the behavior of men who have sex with
men, the institution of anti-homophobia policies, increased
education of healthcare workers, and the reduction of stigma
in healthcare situations. Resources need to target the
most effective interventions, based on sound evidence, said
Chris Beyrer MD, MPH, Director, Johns Hopkins Center for
Public Health and Human Rights. This means focusing on some
of the hardest-to-reach and most stigmatized populations,
including sex workers, people who inject drugs, and men who
have sex with men. The public health urgency to address
these key populations is consistent with the human rights
imperative to include those most in need of HIV prevention,
treatment, and care.