National strategic frameworks or plans (NSPs) determine a country’s national response to HIV and AIDS, guiding allocation of funding, resources and human capacity. They provide a vision of the results a country wants to achieve and the approach for reaching these results over a period of time. Previous reviews of NSPs have found they often lack clear goals and priorities, cost estimates, plans for resource mobilisation, and interventions that are efficient, reliable and feasible. Many plans are not strategic, include limited situational analysis and do not identify the key drivers of the epidemic and the programmes necessary to reverse its course.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has called on development partners to help countries improve NSPs and annual action plans so they are: selective and carefully prioritised; evidence-driven; have clear implementation arrangements and accountability; and include operational monitoring and evaluation. In order to prioritise effectively, analysis of the epidemic should include identification of those subpopulations where most new infections are occurring. This means paying attention to key populations at higher risk of HIV exposure including men who have sex with men, transgender people, sex workers and their clients, people who inject drugs, and people living with HIV.
In Asia, it has been estimated that more than 95 per cent of all new infections among young people are occurring among young key populations at higher risk of HIV exposure. Behaviours which place young people at a higher risk for HIV infection such as unprotected paid sex, unprotected sex between males, and the sharing of contaminated injection equipment, often start at an early age (see Figure 1). It can be difficult for young people, including those from key populations, to access HIV-related information and services. Barriers to access may hinge upon social, cultural, religious, financial, logistical, or legislative issues. These mean young key populations are more likely to have a poor understanding of HIV, inadequate access to health and support services as well as greater engagement in high-risk behaviours. In many countries this is translating into early HIV infection and the potential for escalated growth of the epidemic.
To better understand how countries are tackling the HIV epidemic among young key populations, a number of agencies agreed to partner to investigate how these groups were being addressed in national AIDS strategic plans in the Asia-Pacific region. This report is the outcome of this effort, and aims to inform country-based reviews and progress reports of current NSPs, and the development of future plans with greater attention to these populations.
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