Global Progress on HIV Threatened: WHO

Megan Brooks

July 11, 2014

Five key populations at greatest risk for HIV infection are least likely to have access to HIV prevention, testing, and treatment services, which threatens global progress on HIV, the World Health Organization (WHO) warned today.

They are men who have sex with men (MSM), people in prison, injection drug users, sex workers, and transgender people. In many countries, these populations are left out of national HIV plans, and discriminatory laws and policies pose "major barriers to access," the WHO says.

In the lead-up to the International AIDS Conference in Melbourne, Australia, beginning July 20, the WHO has issued guidelines on HIV prevention, diagnosis, treatment, and care for these vulnerable populations.

For the first time, the WHO strongly recommends MSM consider oral antiretroviral therapy in addition to condoms to help guard against HIV infection. Rates of HIV infection among MSM "remain high almost everywhere and new prevention options are urgently needed," the WHO said in a statement.

The US Centers for Disease Control and Prevention made a similar recommendation for preexposure prophylaxis (PrEP) in May, as reported by Medscape Medical News.

Bold Policies, Bold Results

Worldwide, 20% to 25% reductions in HIV incidence among MSM could be achieved through PrEP, averting up to 1 million new infections among this group over 10 years, the WHO says.

The agency notes that female sex workers are 14 times more likely to have HIV than other women, MSM are 19 times more likely to have HIV than the general population, and transgender women are almost 50 times more likely to have HIV than other adults. Injection drug users can also be 50 times more likely to have HIV infection than the general population.

"None of these people live in isolation," Gottfried Hirnschall, MD, MPH, director of WHO's HIV Department, says in a news release. "Sex workers and their clients have husbands, wives and partners. Some inject drugs. Many have children. Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and well being of individuals, their families and the broader community," he warns.

While fewer people are dying of AIDS, preventive efforts "are still lagging too far behind," particularly among these key populations at greatest risk for HIV, the WHO says.

"Bold policies can deliver bold results," Rachel Baggaley, PhD, from WHO's HIV Department, says in the release. "Thailand was one of the first pioneers of programmes to recognise the need to keep sex workers healthy and reduce new HIV infection. Malaysia, Spain and the United Republic of Tanzania have made major advances in providing opioid substitution therapy and needles and syringe programmes for people who inject drugs. Data show that where a combination of effective HIV prevention and treatment services for people who inject drugs are available, HIV transmission among people who inject drugs is minimal."

At the International AIDS Conference 2014 in Melbourne, the WHO will call on governments to re-energize and strengthen HIV programs so that all key populations benefit from the ongoing advances in HIV prevention and treatment.

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