Key Populations Key Solutions: A Gap Analysis and Recommendations for Key Populations and HIV in South Africa

Published: September 6, 2011

Who are Key Populations?
Men who have sex with men (MSM), transgender people, sex
workers, injecting drug users (IDU), prisoners and migrant1
populations are collectively labelled ‘Key Populations’. They
exist in every region of the world, in every country, and in most
communities. Because they are often marginalised by society
and greatly affected by discrimination and stigma, these groups
have become some of the most at-risk populations for HIV

Key Populations and HIV
Globally, HIV prevalence among Key Populations tends to be
higher in communities where legislation does not ensure their
human rights, specifically where national health responses
fail to ensure their right to health. High levels of prejudice and
moral loading have also been shown to create barriers against
accessing prevention, treatment, and other health care services.
In South Africa, local evidence shows that Key Populations
are greatly affected by HIV and that they account for a
disproportionate number of new HIV infections, thereby
indicating that HIV preventions to date have not reached and
benefited these individuals. In fact, HIV prevalence in these
groups has been measured to be much higher than the general
South African population (Table 1).

Many cost-effective interventions focused on Key Populations
have been shown to decrease the rate of new HIV infections.
Individuals from Key Populations need tailored HIV prevention,
care, treatment and support services to address the structural,
social and individual vulnerabilities that are specific to them.
Why focus on Key Populations?

National efforts to reach zero new HIV infections, zero stigma
and zero AIDS-related deaths will only be achieved through
explicit commitment to addressing the HIV epidemics among
Key Populations as part of South Africa’s overall response to
HIV. The new National Strategic Plan (NSP) on HIV and AIDS,
TB and STIs which will guide South Africa’s HIV response until
2016 must include goals, objectives, targets and evaluation
mechanisms to ensure programmatic implementation for Key
Populations. Additionally, South Africa has committed to act
upon international declarations that refer to addressing the
needs of Key Populations: specifically ‘The UN Declaration
of Commitment to HIV/AIDS (UNGASS)’ and the recent
‘Political Declaration on HIV/AIDS: Intensifying our Efforts to
Eliminate HIV/AIDS’. Therefore, by supporting the needs of Key
Populations, South Africa will be acting to fulfill its international
obligations as well as implementing interventions which are
based on public health and human rights based approaches;
save lives and in many cases save costs.

This policy brief is a summary of the findings and
recommendations of the ‘Key Populations, Key Responses’
report. Commissioned by the South African National AIDS
Council (SANAC) and the South African UN Joint Team on HIV
& AIDS, this report provides a comprehensive situational
analysis of South African men who have sex with men,
transgender people, injecting drug users, sex workers, prisoners
and migrants, and HIV in South Africa. It includes an overview
of completed research, current service provision, gaps and
recommendations for Key Populations. The report was developed
through a literature review and complemented by extensive
consultations with representatives from academic, government,
civil society and other sectors that took place between
November 2010 and August 2011. The full report and relevant
references can be accessed at
za or by emailing

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