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 Healthcollaborated 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.