Sustainability of Programs to Reach High Risk and Marginalized Populations Living with HIV in Resource Limited Settings: Implications for HIV Treatment and Prevention

Published: September 1, 2011

Achieving the levels of antiretroviral coverage to successfully implement treatment as prevention among such hard-to-reach populations as sex workers presents an array of challenges. According to 2009 surveillance data from the World Health Organization, antiretroviral (ARV) coverage with a CD4 cell count threshold of 200 or less was 52 percent worldwide, while coverage on the higher threshold of CD4 count of 350 or less was only 36 percent. Although there is some skepticism about achieving high levels of ARV coverage among sex workers, data from another research study demonstrate that it is possible to achieve high levels of immunological reconstitution and virological suppression among female sex workers. Despite the challenges, the authors believe that not offering ARVs to female sex workers is not an option, and sustainability of these programs relies on the ability to transfer them to national HIV care programs. Unfortunately, these national programs now face declining resources from external donors, such as the President’s Emergency Plan for AIDS Relief (PEPFAR), and must balance high-cost case management interventions against expanded access to antiretroviral medications for the broader population. According to the authors, reaching sex workers with ARV programs will require intensive counseling and case management services focusing on retention and adherence issues. The authors stress that success will rely on increased political will and advocacy from both medical and public health providers.

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