Compared with several years ago, more countries have clearly identified key populations within their National Strategic Plans; more interventions are aligned with those recommended by WHO, UNAIDS, and the Global Fund; and the reach and coverage of key populations with appropriate services is being better measured, including through disaggregation of data by sex and age. As a result, we are now better able to assess what works, which areas of programming are more challenging to implement, and which gaps in services countries should pay particular attention to when planning their programs.
Countries have set ambitious targets for HIV prevention, aligned with the United Nation’s Political Declaration of 2016. Programs for key populations must be designed for scale. This means reliably and safely estimating the size of key populations (in close consultation with community experts); understanding their particular vulnerabilities and service needs; and designing and delivering comprehensive, evidence-informed, rights-based, and high-quality services to reach sufficient enough numbers of individuals to make an impact at the population level. These services must cover not just HIV prevention, but the entire cascade of prevention, diagnosis, treatment, and care for HIV (and for other priority health needs such as sexually transmitted infections, hepatitis, tuberculosis, mental health, and sexual and reproductive health).
Scale, quality and comprehensiveness of services are essential but not sufficient: access is a key issue. In many countries, uptake of services across the prevention and treatment cascade remains poor for key populations, primarily because of barriers related to human rights and gender, including criminalization, religious laws, cultural norms, stigma, discrimination, and violence. For this reason, the Global Fund strategy 2017–20224 stresses the importance of ensuring that services are accessible, acceptable, affordable, and of high quality. A key component of improving access for key populations is to identify, strengthen, and support civil-society, community-based, and key-population led organizations and networks to provide large-scale programming. Such organizations can be well placed to create trusted, safe platforms for service delivery, whether these are direct services via drop-in centers, community outreach workers, or internet-based communications; or tracked referrals to vetted service-providers that are respectful of, and safe for, key populations.

This technical brief on HIV and key populations “Programming at scale with sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prison and other closed settings” is based on lessons learned from an assessment of programs for key populations across 65 countries. The assessment was commissioned by the Global Fund to examine how HIV service packages are designed, delivered, and monitored during the 2017–2019 allocation period.

To read full version of the brief “Programming at scale with sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prison and other closed settings”.