Around the world, the key populations at risk of HIV infection are not getting needed health services, thus hindering progress in the responce to the disease, according to a new report from the World Health Organization (WHO) released on Friday.
The report outlines guidelines for HIV prevention, diagnosis, treatment and key care populations, and for the first time the WHO has recommended that gay, sexually active men take antiretroviral medicine to prevent HIV infection.
"We already know if someone has HIV, using treatment drastically reduces the likelihood of them passing it on, as does using condoms,” Dr. Rosemary Gillespie, the chief executive of the British charity Terrence Higgins Trust, told the BBC. "The idea of treatment as prevention is not new, but the idea of extending treatment to HIV-negative people from high-risk groups is."
HIV infection rates for gay males have stayed high in most places, with these men being 19 times more likely to contract the virus than the general population. However, antiretroviral use, referred to as pre-exposure prophylaxis, could reportedly lower the spread of HIV in this population by 20 to 25 percent throughout the next 10 years. The WHO said improving prevention methods could help prevent 1 million infections.
Dr. Gillespie also told the BBC that pre-exposure prophylaxis was likely to be a future tool for reducing HIV infection, but she said “we need to evaluate how effective it will be in preventing HIV among gay men.”
More general prevention recommendations for all key groups listed in the report include condom use with proper lubricants, post-exposure prophylaxis, and voluntary medical male circumcision.
Other at-risk populations highlighted in the report include female sex workers, transgender women, and individuals injecting drugs with needles. While women prostitutes were 14 times more likely to have HIV than the average population, transgender women and people using needles were 50 times more likely.
“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 well-being of individuals, their families and the broader community,” Dr Gottfried Hirnschall, the director of the HIV Department at WHO, said in a statement.
Based on Joint United Nations Programme on HIV/AIDS (UNAIDS) figures, the key at-risk groups outlined in the WHO report represent up to 50 percent of all new infections around the globe.
With the focus on reducing infection rates among vulnerable populations, the report said from 2009 to 2012, there was a 20 percent reduction in deaths related to HIV. Regardless, the WHO said preventative methods were still in need of improvement.
Access to treatment was found to be unequal for the key populations examined in the report, something which the WHO concluded can have an impact on the spread of HIV. Criminalization of sexual behavior, sexual orientation, gender expression, and drug use further perpetuated discrimination issues.
In addition to unequal access to treatment, in places where confidentiality concerns arise, many people are not getting treatment, UNAIDS Rights, Gender and Community Mobilization Director Mariangela Simao told Voice of America.
“This has been threatened lately, at least in two countries — in Nigeria and in Uganda, related to the obligation of anybody to report if they know of someone who is a gay man or a lesbian,” Simao said. “We have reports from these countries that have documented serious disruptions in the availability and access to HIV and other health services, following the promulgation of these laws."
The WHO found that in locations with supportive HIV services and laws in place, deaths and illness rates related to the virus dropped within the vulnerable groups.
“Bold policies can deliver bold results,” Dr Rachel Baggaley, from WHO’s HIV Department, said in a statement.
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Image via Flickr/NIAID