A client receives their antiretroviral treatment (ART) through home delivery in Togo.
Photo credit: Raymond Varvatos Avosseh for FHI 360
Key Populations (KP) include sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs, and people in prisons and other enclosed settings. Globally, these populations are particularly vulnerable and disproportionately affected by HIV due to certain risk behaviors, marginalization, and structural factors such as stigma, discrimination, violence, human right violations, and criminalization--all which contribute to a lack of access to health services. In 2020, key populations and their sexual partners accounted for 62% of new HIV infections globally.
Key populations are often difficult to reach for critical testing, care, and treatment services. They face a higher risk of acquiring HIV and have higher risk for onward transmission and yet their access to services is limited. Globally, their rates of accessing safe, effective, and quality HIV services are extremely low, while stigma and discrimination, including gender-based violence, are high compared to the general population. Significant barriers, such as police harassment, societal discrimination, and insufficient community-based services prevent them from getting the care they need.
Supporting a Comprehensive Package of Services
USAID engages hard to reach populations and provides client-centered services through community- led programming. Key populations are provided HIV testing, prevention, and care services through differentiated service delivery models, providing services in locations where key populations can be served without discrimination. Key populations face disproportionate structural barriers that impact their ability to access quality HIV services. To build access to services, USAID supports drop-in centers, online and personalized outreach, and alternative pick-up points, such as one-stop-shops that provide community-based treatment initiation and refills in addition to testing services. USAID programming integrates interventions to prevent and respond to violence, address stigma and discrimination, foster enabling policies, promote legal literacy, and support health care worker sensitization and the provision of competent care. In the midst of COVID-19 related disruptions to service, USAID has worked closely with implementing partners to adapt programming and share solutions for ensuring continuity of vital services for key populations.
USAID has developed a comprehensive package of services and approaches through a range of early interventions. The comprehensive package comes from the WHO global key population guidelines, which serve as the standard for all international HIV implementation and guide national government policy and planning.
Comprehensive Package of Services for Key Populations:
- Health Interventions
- Condom and lubricant programming
- Harm reduction interventions
- Behavioral interventions
- HIV testing and counselling
- HIV treatment and care + PrEP
- Prevention and management of viral Hep, TB, and mental health conditions
- Sexual and reproductive health interventions
- Structural Interventions
- Supportive legislation, policy, and funding
- Addressing stigma and discrimination
- Community empowerment
- Addressing violence
USAID promotes HIV prevention through interpersonal communications, provision of condoms and lubricants, and promotion, initiation, and dispensation of PrEP. Testing approaches, including social network testing, index testing, self-testing, and risk network testing, complement traditional peer outreach models and lead to improved case identification of HIV-positive key populations who are otherwise hard to reach. To support HIV treatment and care for key populations, USAID built access to multi-month dispensing for both PrEP and antiretroviral treatment (ART) and dispensed these through clinics or drop-in centers while also referring and supporting clients who get their care from ART sites. USAID key population programs have scaled treatment, care, and viral load services through clinical sites in order to increase access to these essential and lifesaving services, and have also scaled online and virtual approaches for engaging, linking, and retaining clients (and their social networks) into care. These “Going Online” efforts to expand online and virtual channels to accelerate HIV support and epidemic control have been critical during COVID-19.
Within each country with USAID key population programming, a sustainable national response is the goal of USAID’s work. There are many opportunities to leverage the high-quality work funded by PEPFAR to enhance the quality of services in-country. USAID will continue to promote program alignment, identify metrics for program monitoring, and support innovations that can be scaled to support quality programs.
As USAID shifts funding to directly support local partners, core to the USAID mandate is the participation of key population community leaders in the implementation and monitoring of HIV services.
In support of PEPFAR and UNAIDS’ 95-95-95 goals, USAID implements and monitors progress of key population programming across the full cascade of HIV services.
Linkage to Treatment in FY21:
- More than 100,000 members of key populations learned of their HIV-positive status through USAID support;
- More than 100,000 (97%) members of key populations were linked to treatment (independent of the PEPFAR agency supporting the ART site), including 72,795 new clients who were linked to treatment (65%) within USAID programs; and
- Today USAID supports community treatment initiation for key populations in 37 countries.
- PEPFAR Solutions Platform- Key Populations
- WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations (2016 update)
- UNAIDS: Key Population Trusted Access Platforms
- PEPFAR Key Populations Investment Fund Fact Sheet
- KPIF West Africa: Building the capacity of nascent Key Population organizations to drive the HIV response
- EpiC: Long-Term HIV Treatment Adherence for Key Populations
- EpiC Spotlight on PreP
- EpiC Index Testing and Risk Network Referral Training Package
- EpiC Project Blog
- LINKAGES: Violence Prevention and Response Series
- LINKAGES: Reaching the Third 95: Viral Load Suppression among Key Population Individuals Living with HIV