ACT NOW: Leaders Call on UN to Address Key Populations in Primary Prevention of HIV

More than 175 leaders in the field of global sexual health and human rights have endorsed a new publication that lays out steps for a strengthened and more comprehensive global HIV prevention response ahead of this year’s UNAIDS Global Prevention Coalition meeting.

Click here to Sign the Call to Action

Download a PDF of Reconsidering Primary Prevention of HIV

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The world needs a new phase in the evolution of the HIV response—one that reinvigorates prevention by seamlessly combining the efficacy of upstream, midstream, and downstream interventions with the powerful effectiveness of community action.

Gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender women are 24, 24, 13.5, and 49 times more likely to acquire HIV, respectively, than adults in the general population (15 years old and older). Globally, these “key populations” disproportionately bear the burden of new infections, as gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender women accounted for 45% of all new HIV infections in 2015.

Key populations are rendered vulnerable to HIV by upstream factors like punitive and discriminatory laws and politically driven policies, creating stressors that exacerbate risk for acquisition. Moreover, the absence of protective laws and policies enable unchecked stigma and discrimination in healthcare settings. These barriers mean people delay or skip seeking the services they may need, making the problem of HIV even worse.

The persistence of revisionist characterizations of HIV has never and will never change the biology of acquisition:  HIV is primarily transmitted sexually and via blood through the sharing of injecting equipment. For primary prevention to stand a chance, the silence, denial, negativity, and moralism surrounding sex and drug use must end. Policy makers and donors, including governments, must shed their reluctance to openly and positively address sex and drug use in their public health discourse and responses to HIV.

Propelled by the introduction of powerful and life-saving antiretroviral medications, the increasingly bio-medicalized global HIV response challenges us to rigorously reimagine prevention. The prevention toolbox is getting bigger, but the application of the tools is getting smaller. Bio-medicalized interventions, which have been lauded as successes in the HIV response, must be strategically combined with other interventions and delivered by communities for which interventions are intended. Community-led prevention must be properly resourced.

Primary prevention remains seriously undermined by low funding levels that are grossly misaligned with the disproportionate impact HIV is having on key populations worldwide. For example, in the Global Fund to Fight AIDS, Tuberculosis, and Malaria’s 2014-2016 funding period, only $648 million of the $5.9 billion (or 12%) was specifically dedicated to programs intended for all key populations, and less than half of this was dedicated to the primary prevention of HIV.

The social shape of the HIV epidemic requires a return to a primary prevention strategy that is proactive, addresses upstream factors, re-centers communities most impacted by HIV, and properly resources combination approaches chosen and led by communities for which prevention efforts are intended. HIV and other sexual health services done with or led by community members for which the services are intended are more likely to result in earlier, comprehensive, and more frequent service engagement, and improved retention, yielding better health outcomes.

We the undersigned endorse the below core principles of practice to serve as broad guidelines for the design, implementation, and evaluation of primary prevention programs for gay men and other men who have sex with men, people who use drugs, sex workers, and transgender people:

  • The imperative to reduce new sexually transmitted infections, including HIV, should not impinge on personal freedoms;
  • All people, including gay men and other men who have sex with men, people who use drugs, sex workers, and transgender people, have the right to self-determination;
  • All people, including gay men and other men who have sex with men, people who use drugs, sex workers, and transgender people, deserve the same level of support, health, access to services, and political rights as anyone else;
  • All people, including gay men and other men who have sex with men, people who use drugs, sex workers, and transgender people, have the right to privacy and are entitled to a fulfilling and satisfying sex life;
  • Gay men and other men who have sex with men, people who use drugs, sex workers, and transgender people, should be actively and meaningfully engaged at all stages and levels in research, program and policy development, implementation and evaluation—participatory processes should be utilized throughout;
  • Young people, including young gay men, young sex workers, young people who use drugs, and young transgender people should be directly engaged when planning HIV prevention programs, in a non-tokenistic way that recognizes unique factors like consent, emancipation, autonomy, and privacy laws;
  • The primary prevention of HIV should not be risk or deficit oriented—instead, successful HIV prevention efforts should leverage and be rooted in the strengths, resources, individuals and communities;
  • Pleasure, gender, satisfaction, intimacy, love, and desire are key concepts in a fuller understanding of sex and sexuality among gay men and other men who have sex with men, sex workers, transgender people, and of drug use among people who use drugs, and therefore in formulating more meaningful research, programmatic, and policy responses; and finally,
  • Researchers, prevention practitioners, healthcare professionals, and policymakers should consider structural, situational, and contextual factors in understanding HIV acquisition and transmission risk and in developing sexual health interventions tailored to the specific needs of gay men and other men who have sex with men, people who use drugs, sex workers, and transgender people.

We therefore call upon advocates, healthcare providers, researchers, public health officials, and donors to:

  1. Stop chasing magic bullet solutions to HIV and end sloganeering about HIV drug coverage—instead, invest in carefully tailored combination approaches;
  2. Evolve primary prevention in a manner that seamlessly stitches together bio-medical, behavioral, community, and structural interventions, because these interventions lose their effectiveness without the others;
  3. Combine and tailor prevention approaches with consideration to acquisition and transmission dynamics that are specific to key populations—blanket approaches leave people behind;
  4. Imbue HIV primary prevention, care, and treatment with the power of community ownership and abandon top-down approaches;
  5. Remedy funding inequities by investing more substantively, strategically, and differentially in evidence-informed, rights-based, and community-led programs;
  6. Adopt a more nuanced understanding of gender that recognizes the complexity of identities and sexualities; and,
  7. Adopt community-endorsed, human rights-based principles of practice, starting with the Greater Involvement of People Living with AIDS/HIV (GIPA) principle.
The Global Forum on MSM & HIV (MSMGF) IRGT: A Global Network of Transgender Women and HIV
Global Action for Trans Equality (GATE) The International Network of People Who Use Drugs (INPUD)
The Global Network of People Living with HIV (GNP+) The Global Network of Sex Work Projects (NSWP)
The International Community of Women Living with HIV (ICW) The Global Advocacy Platform to Fast-track the HIV and Human Rights Responses with Gay and Bisexual Men (The Platform)
AFEW International Mainline
African Sex Workers Alliance (ASWA) Makerere University Joint AIDS Program
AIDS Action Europe MAMTA Health Institute for Mother and Child
AIDS and Rights Alliance for Southern Africa (ARASA) MASAKA KP HIV Prevention & Support Organization (MAHIPSO)
Aidsfonds MENANPUD
All Ukrainian network of PLWH Michigan State University
Alliance Congolaise pour les Droits Humains de Projets sur le travail du Sexe, ACODHU-TS Mid Island Treatment Society
ALLIANCE.GLOBAL Most At Risk Populations’ Society in Uganda ( MARPS in Uganda)
AMA Myanmar Movimiento de Trabajadoras Sexuales del Perú
Amitiel Welfare Society myISEAN
Angels Refugee Group Association National coalition of people living with hiv in india
APCASO National Users Network of Nepal(NUNN)
APLA Health Network of Maharashtra By People Living With HIV/AIDS
APNSW New Era Legal And Human Rights Foundation(NELEHURIFO)
Arab Foundation for Freedoms and Equality New Zealand AIDS Foundation
Asia Pacific Network of Sex Workers (APNSW) NZProstitutes Collective
Asociación Civil Cambio y Acción Ontario HIV Treatment Network
Asociación Costarricense de Estudios e Intervención en Drogas (ACEID) Organization for social services and health development (OSSHD)
Asociación de Trabajadoras Sexuales Miluska Vida y Dignidad OSSHD
Association of HIV affected women and their families “Demetra” Pakachere IHDC
Astha Samuha Pan African Positive Women’s Coalition-Zimbabwe
Australian Federation of AIDS Organisations (AFAO)
Australian Research Centre in Sex, Health & Society Peers Victoria Resources Society
AVAC PION – Norwegian Sexworkers rights
Awaken Resistance PLAPERTS REGIONAL (Plataforma Latinoamericana de Personas que Ejercen el Trabajo Sexual)
Badlaav Samiti PNG- Friends Frangipani Inc
BesD e.V. Berufsverband erotische und sexuelle Dienstleistungen e.V. Positive Malaysian Treatment Access & Advocacy Group (MTAAG+)
Bridging the Gaps Alliance Positive Voice (Patients’ Organisation for PLHIV in Greece)
Canadian HIV/AIDS Legal Network Positive Women Inc. Aotearoa New Zealand
Caribbean Vulnerable Communities Prevention Access Campaign
Cebuplus Association, Inc. PT Foundation
Centro Cáritas de formación para la atención de las farmacodependencias y situaciones críticas asociadas A.C. Red Umbrella Sexual Health and Human Rights Association
Change Agents REDCA+ (Central America Network of People with Hiv)
Children’s Hospital-Division of Adolescent and Young Adult Medicine Religious Empowerment in Gender, Health, Sexuality and Rights (REGHESER)
China sex worker organization Network Reseau Solidarité pour le Droit des Travailleuses du Sexe au Burundi
Christ Soldiers Foundation Robert Carr civil society Networks fund
Coalition of Drug Users in Nepal Ron Simmons Consulting
Cohealth Ronald Thomas & Rajdeep Saikia
Community Health Education Services and Advocacy Rose Alliance
CONERELA+ Rumah Cemara
CSWC Rural Renewal and Community Health Development Initiative (RuRCHeDI)
David Bradford Salamander Trust
Debby Doesn’t Do It For Free SATHI SAMUHA
Destiny Makers Organization (DEMAO) SEARN-SRHR
Doctors for Asylees Sex Workers Outreach Project, Sacramento
društvo AREAL shanghai CSW&MSM Center
EKHN – Eurasian Key Populations Health Network SOMOSGAY
Equal health & rights access advocacy initiatives STAR-STAR
Eurasian Women’s Network on AIDS Stephen Talugende
FPA UK STRASS Syndicat du Travail Sexuel
Geneva Center for Education and Resarch in Humanitarian Action Students for Sensible Drug Policy Australia
Global Justice Institute, Metropolitan Community Churches Sudanese PLHIV Care Association
Global Network of Black People working in HIV SWAN – Sex Workers’ Rights Advocacy Network in CEECA
Groupe sida Geneve SWARM
Heartland Alliance International T-Women Ukraine
HESED Tamaulipas Diversidad VIHDA Trans A.C.
HIV Justice Network Tanazania network for people who use drugs (TaNPUD)
Hiv-Sverige / HIV-SWEDEN Terrence Higgins Trust
HivNorway The Institute of Many (TIM)
Hivos LAC The Transgender Welfare Society
Hivsters Total Health Empowerment and Development Initiative (THEDI)
Homme pour les Droits et la Santé Sexuelle, HODSAS RDCongo Trans Wellness Project
HOPS – Healthy Options Project Skopje TWEET transgender network in india
Hornet Gay Social Network UCO “Legalife-Ukraine”
Humanity First Cameroon UDYAMA
Hwupenyu Health and Wellbeing Ukhondo Services Foundation
India HIV/AIDS Alliance Union C
Indian Drug Users Forum Unitarian Universalist Church in Reston
International Association of Providers of AIDS Care University of Glasgow
International Committee on the Rights of Sex Workers in Europe (ICRSE) Urban Survivors Union
International Drug Policy Consortium (IDPC) VAMP
International Federation of Medical Students’ Associations Venas Abiertas: A network of latinx immigrnat PLHIV
International HIV/AIDS Alliance Warembo Forum
International Planned Parenthood Federation (IPPF) Women and the Harm Reduction International Network (WHRIN)
Ishtar Women for Freedom
Ishtar Msm Women’s Harm Reduction International Network
John Mordaunr Trust Women’s Organisation Network for Human Rights Advocacy (WONETHA)
Kristine Dreuilhe YKP LEAD Nepal
Life Inclusive Youth LEAD
Life Line Person Living With Hiv Aids tuberculosis Welfare Society Samiti Youth Vision
Lighthouse Social Enterprise YouthRISE, Nigeria
Loaded Content Zi Teng
M-Coalition Zimbabwe Sex Workers Alliance

Download a PDF of Reconsidering Primary Prevention of HIV
Click here to Sign the Call to Action