With five new HIV infections for every three people that receive treatment it is time to put prevention at the core of the HIV response.
Key populations (people who are at higher risk of HIV) play a critical role in effectively preventing HIV. Key populations can include men who have sex with men (MSM), sex workers and people who inject drugs.
If we do not meet the needs of key populations, promote and protect their rights and support them in becoming equal partners in the HIV response, we will not succeed in halting the spread of HIV.
That’s why our prevention work is rooted in community action, rights-based, targeted to those who are at highest risk and especially vulnerable to HIV, and takes an evidence-based combination approach.
In 2010 we launched the ‘What’s Preventing Prevention’ campaign. The campaign is calling on donors and governments to guarantee a more effective HIV prevention response.
Despite a decline of 19% in the number of people newly infected with HIV in the last decade, the HIV epidemic still outpaces the response. By now, the importance of key populations in the HIV response is widely acknowledged, but it is still not sufficiently reflected in national strategic HIV plans, investments in prevention services, and the actual response on the ground. On the other hand, there is a growing body of knowledge on HIV prevention and a range of new tools that can help making programmes more effective. These new tools include treatment as prevention, pre-exposure prophylaxis of HIV or 'PrEP', home based testing.
Moreover, the last two years have seen important breakthroughs in biomedical prevention technologies and the beginning of a global movement to revolutionise the prevention response through community leadership, ensuring equitable access to high-quality, cost-effective HIV prevention programmes, and advances in human rights and gender equality.
Now is the time to focus prevention efforts on key populations and highly affected communities in order to make the greatest impact on HIV.
Alliance Approach: mobilising key populations and communities
We mobilise and support key populations and highly affected local communities to become equal partners in the HIV prevention response. This involves developing and strengthening community systems and supporting community action for HIV prevention through a variety of interactive tools and strategies, for example:
- Community assessments with key populations feeding into the design, implementation and evaluation of prevention programmes
- Capacity building of community-based organisations, networks and community leaders
- Development and delivery of prevention activities, services and commodities at community level
- Sensitising e.g. policy makers, health and other support services and the police force to the needs and rights of key populations, as part of our efforts to create an enabling environment.
- Establishing and strengthening linkages with other organisations and services providing complementary action.
Our prevention programmes take a sex positive and gender-sensitive and transformative approach and embrace positive health, dignity and prevention for people living with HIV. We also promote and support the integration of HIV prevention with HIV treatment, care and support and other health services, such as sexual and reproductive health and maternal, newborn and child health. We work with children and adolescents as much as adults.
Our prevention approach is defined by our policy position paper on prevention, our good practice HIV prevention programming standards, good practice HIV programming guides and regular HIV Technical Updates and Discussion papers.
Prevention with key populations continues to be a core activity of the Alliance across the globe. The following overview highlights some key activities in each region. More information on our country programmes is available here.
Asia and Eastern Europe
Our Linking Organisations (LOs) and Country Offices (COs) and their partners in Asia and Eastern Europe are implementing some of our largest combination prevention programmes. For example the Pehchan programme (2010-2015) implemented by India HIV/AIDS Alliance that strengthens and builds the capacity of community-based organisations to provide combination HIV prevention for men who have sex with men, transgender people and hijras in 17 Indian states, and the Avahan India AIDS Initiative (Phase I 2003-2009, Phase II 2009-2013), which is a focussed prevention initiative funded by the Bill & Melinda Gates Foundation.
In Ukraine, the International HIV/AIDS Alliance in Ukraine is scaling up the national HIV prevention response for key populations (men who have sex with men, sex workers, people who use drugs, children living and working on the street, prisoners, and people living with HIV) through programmes funded by the Global Fund and the USAID-funded SUNRISE project. Alliance Ukraine has recently featured with a case study on its successful combination prevention approach in AIDSSTAR I.
In Cambodia, KHANA is now the largest local HIV/AIDS non-governmental organisation supporting 66 partners e.g. through training on standard packages of activities for programming with key populations and youth and demonstration centres.
In Africa our LOs and COs and their partners have developed many innovative models to strengthen the prevention response, e.g.: the network support agents model of the Community Health Alliance Uganda for working with networks of people living with HIV to increase access to HIV services and address stigma and discrimination, and the ANCS model in Senegal to improve health in rural districts, reach highly vulnerable and underserved groups such as mobile populations and the military, and support prevention of mother-to-child transmission work. ANCS also has a strong policy presence and is a member of the civil society HIV/AIDS watchdog l’Observatoire.
In Cote d’Ivoire, Alliance Nationale contre le SIDA is building the capacity of local community based organisations in combination prevention with key populations (notably sex workers and men who have sex with men); and is extending voluntary HIV counselling and testing services through inter-sector partnerships.
Our Africa Regional Programme (ARP) that has been operating since 2005 supports activities at the national and regional level, working through Alliance partners in more than ten countries. The ARP promotes more effective, targeted HIV prevention responses that meet the needs of some of the most neglected key populations in sub-Saharan Africa and address structural factors such as harmful gender norms.
Latin American and the Caribbean
The Alliance works with key populations (transgender people, sex workers, people living with HIV, people who inject drugs, gay men and other men who have sex with men) in the Latin American and Caribbean region through programmes in Ecuador, Mexico, Bolivia, Peru, El Salvador, and Colombia, and in the East Caribbean. These populations suffer high levels of stigma and discrimination. Thus, prevention work focuses particularly on advocacy work and on creating an enabling environment. We also run a Latin America and Caribbean Regional Programme that covers most countries in the region, in partnership with major regional community networks. In 2008 the Alliance launched Portal SIDA, a Spanish-language website that collects HIV-related knowledge, news, events and information about organisations and people responding to HIV.
Drawing on the global experience of the Alliance
Through the work and experience of our partners across the globe we have been able to contribute to policy and advocacy work at the international level. Through cooperation with international and regional networks such as the MSMGF and RedTraSex, international working and advisory groups such as the UNAIDS Prevention Reference Group and through our 'What’s Preventing Prevention?' campaign Alliance partners have contributed to international and national guidance on prevention and continue to gather and share the evidence on successful combination prevention programmes to support the global response.