MELBOURNE, Australia – The World Health Organization (WHO) announced on Monday, July 21 that progress made in the global health response to HIV may suffer setbacks if HIV services are not made adequately available to 5 key populations: men who have sex with men (MSM), people who inject drugs, sex workers, transgender people and people in prison and other closed settings.

The announcement was made at the 2014 AIDS Conference in Melbourne. 

Recent studies by the Joint United Nations Programme on HIV/AIDS (UNAIDS) suggest that up to 50% of all new HIV infections globally are among these key populations.

Transgender women and injecting drug users are almost 50 times more likely to have HIV than the general population, while sex workers are up to 12-15 times more likely to have HIV.

However because of stigma and discrimination, laws that penalize their behavior, and their exclusion from national HIV response plans, these groups are among the least likely to seek care and treatment. 

“We have seen major progress, specifically in the area of treatment,” said Gottfried Hirnschall, director of the WHO HIV department. “But in all parts of the world, these key populations have comprised access to HIV services and have an increasing rate of new infections.”

Hirnschall called the rate of infection indicative of “explosive epidemics with rates that we have not seen before” particularly among men who have sex with men.

Treatment as prevention

In response to this, the WHO released today consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations.

This report is designed to assist health officials and policymakers develop HIV programs that will increase access to HIV testing, treatment and key and reduce HIV infection in these five key populations.

The guidelines recommend that men who have sex with men consider pre-exposure prophylaxis or taking anti-retroviral medication even if they are HIV negative as an additional measure of HIV prevention.

Pre-exposure prophylaxis or PrEP, (prophylaxis meaning “to prevent or control the spread of an infection) could reduce HIV incidence among MSM by 20-25% and avert up to 1 million new HIV infections over the next 10 years.

“The recommendation of PrEP is to be considered as a prevention option for MSM. This is an option for the men who may want it,” said Chris Beyrer, director at the Johns Hopkins Fogarty AIDS International Training and Research Program.

Beyrer emphasized that PrEP is not to replace the usual prescribed HIV prevention tools like condom use combined with water-based lubricant.

“Just as we would not tell women who don’t want to get pregnant to take only the pill,” said Beyrer.

In 2013, there were an estimated 13 million people taking anti-retroviral therapy (ART) which has resulted in a 20% drop in HIV-related deaths between 2009 and 2012.

“None of these people [in the key populations] live in isolation. Sex workers and their clients have partners. Many have children,” said Hirnschall. “Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic. 

UNAIDS estimates that globally there are about 35 million people living with HIV. Of this number, about 19 million do not know that they have the virus. – Rappler.com

Ana P. Santos is a regular contributor for Rappler apart for her DASH of SAS column, which is a spin off of her website, Sex and Sensibilities (SAS). In 2012, Ana was awarded a media grant to write about women who are most affected by the absence of an RH Law. Read the complete story onRosalie Cabinyan and Laura Jane Duran here. Follow her on Twitter at @iamAnaSantos.