New WHO Report on Gaps in Key Population Programming within National Strategic Plans in Africa

A new report released by the WHO Regional Office for Africa calls on countries to increase coverage of key populations in National HIV Strategic Plans (NSPs). A country’s NSP plays a vital role in guiding the understanding of the national epidemic and the collective actions necessary to achieve an effective response. NSPs are referenced during the development of Global Fund concept notes and PEPFAR Country Operational Plans; in other words, interventions that are not mentioned in NSPs are less likely to be included in financial requests to multilateral and bilateral donors to support the implementation of national strategies.

The new WHO report, which MPact reviewed, identifies strengths, weaknesses, and gaps in the ways that NSPs consider key populations. Civil society, development partners, and communities should utilize this valuable tool to monitor national approaches to address the HIV-related needs of key populations, including gay men and other men who have sex with men, transgender people, sex workers, people who inject drugs, and people in prisons and other closed settings.

The WHO and UN define these five populations as key populations due to the structural barriers to services that compound their risk to exposure. These barriers include factors such as laws that criminalize their behavior and identities as well as prevalent stigma, discrimination, and violence that these populations face. While additional populations may also be disproportionately affected by HIV, we believe it is imperative that all countries specifically address the unique challenges and structural barriers facing gay men, trans people, sex workers, people who use drugs, and people in prisons and other closed settings, in order to end the epidemic.

The assessment of 45 NSPs in the Africa region[1] found that only 41 countries mention gay men and other men who have sex with men, and only 10 refer to transgender people. Too few NSPs acknowledged the interlinkages across key population communities, i.e., male and transgender sex workers, gay men and trans people who use drugs, or young people in key populations. Additionally, epidemiological information about key populations was often limited to prevalence data, indicating that there are gaps in evidence to inform tailored responses.

With regard to the interventions described for key populations, most of the NSPs that were reviewed focused on HIV prevention and HIV testing services, with some NSPs included innovative strategies such as PrEP, self-testing, and assisted partner notification. Countries are advised to align their interventions with the WHO’s Consolidated Guidelines for HIV Prevention, Diagnosis, Treatment and Care for Key Populations (2016), which includes reviewing structural barriers and funding critical enablers to address them. A national HIV plan that fails to include efforts to reduce stigma, discrimination, violence, and criminalization will not see significant changes to the epidemic among key populations.

Another alarming finding from the report was that only half of the NSPs that were reviewed mentioned involvement of communities, despite a wide range of evidence that shows the involvement of key population-led groups is a crucial element for successful responses. Without the leadership and meaningful involvement of key populations, mainstream HIV programming will not reach these communities.

At a moment when donor governments are retreating from a committed focus on key populations, this report is essential to equip civil society, development partners, and communities in the African region to understand the ways that key populations are considered in their National HIV Strategic Plans and to monitor whether NSP content matches the programming realities on the ground. Advocates must continue to increase pressure on all donors and national AIDS control programs that are developing new NSPs to fund and implement evidence-based interventions in line with WHO guidelines for all key populations.

[1] Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cape Verde, Cameroon, Central African Republic, Chad, Comoros, Congo, Cote d’Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Cambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, South Sudan, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe.