Reaching Key Populations: A Critical Priority to Controlling the AIDS Epidemic

Published: April 1, 2011

In most countries HIV is a disease that discriminates, disproportionately affecting society’s most vulnerable. Even in generalized epidemics in which a significant share of the wider population is living with HIV/AIDS, people in vulnerable communities often have considerably higher rates of HIV infection.
Despite the urgent need for scaled-up HIV prevention services for populations at highest risk and the availability of an expanding variety of prevention strategies, the world has largely ignored the plight of these individuals. This reality is deeply concerning in part because the lack of attention to HIV prevention among these populations also undermines the overall response to the epidemic. Reaching vulnerable populations with effective HIV prevention and treatment is critical to bringing the AIDS epidemic under control.

In most countries HIV is a disease that discriminates, disproportionately affecting society’s most vulnerable. Even in generalized epidemics in which a significant share of the wider population is living with HIV/AIDS, people in vulnerable communities often have considerably higher rates of HIV infection.
Despite the urgent need for scaled-up HIV prevention services for populations at highest risk and the availability of an expanding variety of prevention strategies, the world has largely ignored the plight of these individuals. This reality is deeply concerning in part because the lack of attention to HIV prevention among these populations also undermines the overall response to the epidemic. Reaching vulnerable populations with effective HIV prevention and treatment is critical to bringing the AIDS epidemic under control.

Populations at Highest Risk Are at the Center of the Global AIDS Pandemic
Addressing HIV among high-risk groups is crucial for a number of reasons:
• Significantly higher risk of becoming infected. According to conservative estimates, sex workers are roughly eight times more likely to be infected with HIV than other adults, MSM are 15 times more likely, and IDUs are 32.5 times more likely.1 These disproportionate risks are apparent not only in concentrated or low-prevalence epidemics, but also in generalized epidemics in sub-Saharan Africa, where sex workers2 and MSM3 are at least four times more likely than other adults to be living with HIV.
• A substantial share of new HIV infections. Vulnerable populations are heavily affected in concentrated epidemics outside sub-Saharan Africa. Yet even within Africa, these groups account for a notable share of new infections. In countries such as Mozambique and Kenya, sex workers, MSM, and IDUs together represent between one-quarter and one-third of all new HIV infections.4 Globally, sustained progress in reducing rates of new infections will not be possible without implementing effective HIV prevention strategies for populations at highest risk.
• Major risks of transmission to other groups. In addition to the considerable health risks experienced by these populations, their high HIV prevalence also affects broader efforts to bring Reaching Key Populations: A Critical Priority to Controlling the AIDS Epidemic

In most countries HIV is a disease that discriminates, disproportionately affecting society’s most vulnerable. Even in generalized epidemics in which a significant share of the wider population is living with HIV/AIDS, people in vulnerable communities often have considerably higher rates of HIV infection.
Despite the urgent need for scaled-up HIV prevention services for populations at highest risk and the availability of an expanding variety of prevention strategies, the world has largely ignored the plight of these individuals. This reality is deeply concerning in part because the lack of attention to HIV prevention among these populations also undermines the overall response to the epidemic. Reaching vulnerable populations with effective HIV prevention and treatment is critical to bringing the AIDS epidemic under control.

Populations at Highest Risk Are at the Center of the Global AIDS Pandemic
Addressing HIV among high-risk groups is crucial for a number of reasons:
• Significantly higher risk of becoming infected. According to conservative estimates, sex workers are roughly eight times more likely to be infected with HIV than other adults, MSM are 15 times more likely, and IDUs are 32.5 times more likely.1 These disproportionate risks are apparent not only in concentrated or low-prevalence epidemics, but also in generalized epidemics in sub-Saharan Africa, where sex workers2 and MSM3 are at least four times more likely than other adults to be living with HIV.
• A substantial share of new HIV infections. Vulnerable populations are heavily affected in concentrated epidemics outside sub-Saharan Africa. Yet even within Africa, these groups account for a notable share of new infections. In countries such as Mozambique and Kenya, sex workers, MSM, and IDUs together represent between one-quarter and one-third of all new HIV infections.4 Globally, sustained progress in reducing rates of new infections will not be possible without implementing effective HIV prevention strategies for populations at highest risk.
• Major risks of transmission to other groups. In addition to the considerable health risks experienced by these populations, their high HIV prevalence also affects broader efforts to bring national epidemics under control. In West Africa, it is estimated that 13-29 percent of men may have paid for sex in the last 12 months,6 resulting in substantial risks of HIV exposure to the female sex partners of these men. A considerable percentage of MSM also have sex with women.7 And in Eastern Europe and Central Asia, where epidemics have historically been overwhelmingly rooted in intravenous drug use, a growing share of new infections are among the sex partners of HIV-positive drug users.8 In particular, female partners of IDUs are at a heightened risk because many are unaware of their partners’ drug use or unwilling to acknowledge it, a situation that jeopardizes personal and child health.

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