How national AIDS responses are failing in prevention efforts

Published: June 1, 2011

June 2011

The International HIV/AIDS Alliance (the Alliance) believes that all communities have the right to
equal access to high quality prevention, treatment and care services. This includes communities
who are most marginalised, such as sex workers, men who have sex with men, transgender
people and people who inject drugs.
As world leaders prepare to meet in June at the 2011 UN General Assembly High Level
Meeting on AIDS, the Alliance has released this campaign briefing which provides an analysis
of how national AIDS responses are failing in their prevention efforts for key populations.
It includes:
1. an OVERVIEW of the data provided to the United Nations,
2. the RELEVANCE of key populations and targeted prevention programmes,
3. an ANALYSIS of country reports, and
4. recommended SOLUTIONS which are based on the Alliance’s experience of
supporting communities who are at higher risk of HIV infection for the last 17 years.

Several decades after the start of the global AIDS pandemic, data confirms that most low- and
middle-income countries still do not adequately focus their HIV prevention efforts on the key
populations of sex workers, men who have sex with me, transgender people, and people who
use drugs.

Of all low- and middle-income countries1 that report standard information to the United
Nations on their AIDS responses, more than half fail to include timely data concerning
these key populations.

According to the Alliance, which has conducted a review of 132 country reports, this is a strong
indicator of the current level of national AIDS efforts devoted to reaching populations that are
most affected by HIV.

The most recent global information-gathering exercise was carried out for the UN High Level
Meeting on AIDS in June. Twenty-five globally harmonised indicators were designed to form
the basis of the Secretary General’s report. Eight of these focus on sex workers, men who have
sex with men, and injecting drug users. 2 However, of low- and middle-income countries that
participated in the latest reporting round, fewer than half provided recent information about
these key populations.

1 Reports were reviewed from countries defined as low- and middle-income by the World Bank: “How we
Classify Countries,” viewed 20 Aug 2010:

2 Transgender people are not explicitly included in the UN global indicators
Supporting community action on AIDS in developing countries

2. RELEVANCE of key populations
Key populations are at higher risk of HIV infection in countries with generalised AIDS epidemics,
where large percentages of adults are affected, as well as in countries with concentrated
epidemics that are more usually associated with these groups. As such, sex workers, men who
have sex with men, transgender people and injecting drug users are increasingly recognised as
highly relevant to HIV responses in countries throughout the world.3
For instance, in Africa sex workers are more than four times as likely as the general population
to be HIV-positive.4 Men who have sex with men also constitute key populations in African
countries with general HIV epidemics. They are twice as likely to be HIV-positive as the general
population in Kenya, Malawi, Tanzania and Zambia, five times as likely in Nigeria and seven
times as likely in Sudan.5 HIV among injecting drug users (IDU) is more geographically specific,
but IDU represent one-third of all new HIV infections outside sub-Saharan Africa and are the
most affected population group in Eastern Europe and central Asia.6 Transgender people are
an important population affected by HIV, particularly in countries throughout Latin America and
in parts of South and South-East Asia, although country-level tracking of HIV often combines
data for transgender people with information on MSM or ignores them altogether.
What is missing?

It is generally recognised that many countries lack focused prevention programmes that are
scaled up. Such programmes generally consist of strategically designed and targeted packages
of prevention interventions that meet the needs of populations most affected by HIV. As a first
step, these need to be put in place. In addition, they need to be delivered at scale to have
population-level impacts on overall HIV transmission.
The most well-documented example of focused prevention has been the Avahan project, which
reached sex workers, men who have sex with men and hijra (transgender people) in Indian
states with high rates of HIV prevalence.7 8 However, it remains one of a small number of
examples of large-scale HIV prevention programmes that have been demonstrated to effectively
meet public health needs.

Taken as a whole, the recent global data submitted to the UN not only confirms that
large-scale, focused HIV prevention programming is missing. It also underscores the
total absence of attention that is being paid to key populations by most national AIDS

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