||Launch of the WHO consolidated Guidance on HIV prevention, diagnosis, treatment and care for Key Populations
||Melbourne Room 1
||20.07.2014, 15:45 - 17:45
Ruth Morgan Thomas, United Kingdom
Chris Beyrer, United States
Rachel Baggaley WHO, Geneva
This session presents the new WHO consolidated guidelines on HIV prevention, diagnosis, care and treatment for key populations and discuss how these guidelines can be used to promote an equitable and effective response to HIV epidemics.
It is becoming increasingly apparent that the proportion of new infections in all epidemic contexts in people from key population groups has risen significantly, yet this is largely unmatched by funding and effort. Many countries have not developed comprehensive HIV prevention, treatment and care programmes for their key populations. Previous WHO guidance on specific KP did not always adequately address the common issues across KP, and the need for a coherent approach informed by a situational analysis. These guidelines aim to bring together the five KP groups (MSM, sex workers, PWID, people in prisons and transgender people) into one guideline combining existing WHO guidance, tools, strategic information, new recommendations and consider implementation issues
|15:45||Introduction and opening remarks|
H. Nakatani, Switzerland
S. Waqa, Fiji
G. Yadav, India
|15:50||WHO consolidated Guidance on HIV prevention, diagnosis, treatment and care for key populations|
G. Hirnschall, WHO
|16:00||New recommendations on PrEP|
F. Mesquita, Brazil
|New recommendations on overdose management|
N. Clark, Switzerland
R. Birgin, Australia
|An often forgotten key population: issues for transgender people|
K. Montecarlo Cordova, Philippines
|16:30||Working despite legal and social constraints: how effective programmes for key populations can be delivered in difficult environments|
K. Makofane, United States
|16:40||The impact of implementing the key population guidelines|
T. Hallett, United Kingdom
|New recommendations on overdose management - |
|New recommendations on overdose management - Ruth Birgin|
|New recommendations on overdose management - Ruth Birgin|
|An often forgotten key population: issues for transgender people - Kate Montecarlo Cordova|
Youth report by Joanna Williams
session presented the new WHO
consolidated Guidance on HIV prevention, diagnosis, care and treatment for Key
Populations and discussed how these guidelines can be used to promote an
equitable and effective response to HIV epidemics. Importantly, the guidelines include a specific focus on
interventions for adolescents and youth from key populations. While studies are
limited, they consistently show that younger cohorts are more vulnerable than
their older counterparts to STIs, HIV and other sexual and reproductive health
problems and that these groups require age-appropriate interventions.
While there is a lack of knowledge on how best to implement programs to address
the specific needs of adolescents and youth, the guidelines point out that
programmes must be designed and delivered in a way that takes into account the ‘multiple
and overlapping vulnerabilities that confront adolescents from key populations’.
They also highlight policy
and legal barriers affecting access to services. While adolescents and young
people are affected by a range of laws of policies, one area identified as specifically impacting this age group is
age of consent laws. While
such laws vary between nations, adolescents under the age of 18 are often
legally classified as minors and require parental consent for medical care,
including HIV services. As this may discourage adolescents from accessing
services, the guidelines encourage countries to review their age of consent
policies and consider revising them to reduce age-related barriers to HIV
were informed by a wide-scale international consultation with adolescents and
young people from key populations.
Track D report by Carlos F. Caceres
Session organized by WHO covered the launching of the new WHO Consolidated
Guidelines for HIV prevention and treatment among 5 key populations of global
importance: men who have sex with men (MSM), transgender people (with a focus
on transgender women), sex workers, prison inmates, and people who inject
drugs. The guidelines are not limited to adults, but include aspects of
specific importance to young people.
session, chaired by Chris Beyrer and Ruth Morgan-Thomas, was opened by WHO’s
Deputy Director on Infectious Diseases, assisted by two youth representatives.
After him, Dr. Gottfried Hirnschall, Director of the HIV Programme, presented
an overview of these guidelines, completed in a very short period of time (9
months). He described that most of the recommendations already existed in
separate sets or come from different departments in WHO. Some of them were,
however, new, including: (1) A strong recommendation for the use of oral HIV
pre-exposure prophylaxis (PrEP) among MSM; and (2) more clear directions for
the use of harm reduction and opioid substitution therapy with injection drug
users. Issues about the reduction of treatment toxicity were also presented.
Strong emphasis was made on the need to address critical enablers in any honest
response to HIV among key populations, including decriminalization of these
populations’ practices (or of the transmission of HIV), improved access to
prevention and care, reduction of stigma and discrimination, and community
empowerment. Finally, the potential impact of combined biomedical interventions
was presented from a modeller’s perspective.
in the session expressed enthusiasm for the political standpoint adopted by WHO
in clearly focusing on evidence and defining how an honest response to HIV implies changes in many of
the practices that states still adopt against key populations at present.
Track E report by Bridget Haire
This session outlined the contents of the WHO Consolidated Guidelines on HIV prevention, diagnosis, treatment and care for key populations, and presented the rationale for the approaches taken in the document.
The key populations addressed in the document are:
1. men who have sex with men
2. people in prisons and closed settings
3. people who inject drugs
4. transgender people, with a particular focus ontransgender women.
Gottfried Hirnshall provided a general overview, explaining the criteria for being defined as a key population for HIV, which include experiencing high degrees of risk, vulnerability, stigma and discrimination andcompromised access to services. Populations, such as girls and young women, who face increased risk and vulnerability in particular geographical settings such as sub-Saharan Africa, are not included as ‘key populations’ in this document.
Fabio Mesquia outlined the controversial new recommendationfor the provision of pre-exposure prophylaxis (PrEP) in addition to other forms of HIV prevention in populations of men who have sex with men. He reiterated that the evidence shows that PrEPworks and is safe if taken as prescribed and that evidence from the demonstration projects indicates that feasibility looks positive in this population.
Mesquia and other speakers, notably chair Ruth Morgan, discussed how PrEP acceptability in other key populations such as people who inject drugs and sex workers was not yet established, particularly due to the concern that the ‘medical magic bullet promise’ could be used by governments asan excuse not to introduce or scale up other proven prevention interventions.
Ruth Birgen spoke about the inclusion of an important element of the harm reduction package, the drug naloxone, which acts as an antidote to opioid overdose, pointing out that overdose is leading cause of death in PWID with HIV. She argued that community access to this drug is critical to saving lives in this population.
Kate Montecarlo Cordova addressed the special vulnerability of transgendered people, and decried the practice of aggregating data on transgender women with MSM, thus making invisible the extremely high HIV incidence and prevalence in this population. She called for supportive laws and legislation, including decriminalisation of behaviours of key populations,community empowerment and health services made available, acceptable andaccessible to members of key populations, and programs to address violence.
Keletso Makofane spoke about the need to take a pragmatic approach regarding key populations in countries where there are repressive laws, and discussed ways to minimise barriers to health services in such contexts.
Question time included discussion of the cost effectiveness of PrEP, with presenter Timothy Hallett arguing that the health maximisation principle is more important that simplistic applications of cost effectiveness calculations. The need to utilise a range of tools for key populations – social, legislative, biomedical– was emphasised, as was the need for the implementation of the WHO guidelines to include widespread negotiation and communication with healthcare workers.