Hurdles to access HIV services

Sex workers, drug users, people in prison, men who have sex with men and transgender people are at higher risk of HIV than the general population — a risk that is heightened if the person is young. However, most of these people at risk of HIV are not getting the health services they need. Failure to provide adequate HIV services for the key groups threatens global progress on the HIV response, warns World Health Organisation (WHO).
These people are most at risk of HIV infection yet are least likely to have access to HIV prevention, testing and treatment services. In many countries they are left out of national HIV plans, and discriminatory laws and policies are major barriers to access.
WHO has recently released "Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations" that outline steps for countries to reduce new HIV infections and increase access to HIV testing, treatment and care for these five key populations. WHO also recommends countries need to remove the legal and social barriers that prevent many people from accessing services.
For the first time, WHO strongly recommends men who have sex with men and not yet infected, to consider taking antiretroviral medicines as an additional method of preventing HIV infection medically called pre-exposure prophylaxis alongside the use of condoms.
Rates of HIV infection among men who have sex with men remain high almost everywhere and new prevention options are urgently needed.
Modelling estimates that, globally, 20-25% reductions in HIV incidence among men who have sex with men could be achieved through pre-exposure prophylaxis, averting up to 1 million new infections among this group over 10 years. Studies indicate that women sex workers are 14 times more likely to have HIV than other women, men who have sex with men are 19 times more likely to have HIV than the general population, and transgender women are almost 50 times more likely to have HIV than other adults. For people who inject drugs, studies show the risks of HIV infection can be also 50 times higher than the general population.
None of these people live in isolation and failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and wellbeing of individuals, their families and the broader community.
There are still significant gaps in addressing their needs in national HIV plans. Globally, just 70% of countries surveyed explicitly address the needs of men who have sex with men and sex workers, while the figure for injecting drug users was 40%. Transgender people are rarely mentioned in HIV plans. And even where policies exist on paper, it is hard for people to access services that can help them.
These new guidelines highlighted comprehensive HIV packages for prevention, diagnosis, treatment and care for the five key populations and address specific issues and needs of adolescents from these groups. These include measures to better manage sexual and reproductive health, mental health and co-infections such as tuberculosis and hepatitis. They highlight the need for needle and syringe and opioid substitution therapy programmes and include recommendations for treatment of overdose in the community.

Source: World Health Organisation