The most recent global HIV data have brought great optimism that controlling the HIV epidemic could become a reality. These encouraging data show overall declines in both AIDS‐related deaths and new HIV infections worldwide 1. Recent data also demonstrate impressive gains toward the global 90‐90‐90 targets. As of 2016, an estimated 70% of all people living with HIV (PLHIV) globally knew their HIV status. Among those who had been diagnosed, 77% were accessing antiretroviral therapy, and 82% of people on treatment had achieved viral suppression 1.
Despite this progress, the optimism is tempered by concern that reducing HIV incidence rates must be further accelerated to guarantee epidemic control 2. Moreover, the recent gains have not been uniform. While global data indicate important achievements in addressing the epidemic among key populations – defined by the World Health Organization (WHO) as men who have sex with men (MSM), sex workers, transgender people, people who inject drugs (PWID), and prisoners 3 – these gains still lag far behind those made in the general population.
UNAIDS estimates that 44% of all new HIV infections among adults worldwide occur among key populations and their partners 1. In generalized epidemic contexts of sub‐Saharan Africa, key populations and their sexual partners account for 25% of new HIV infections, while in concentrated epidemic settings, they account for as much as 80% of infections 1. Globally, sex workers, MSM and PWID are 10, 24 and 24 times more likely, respectively, to acquire HIV compared with the general population ages 15 years and older 4. Transgender women are 49 times more likely to be living with HIV and prisoners are five times more likely to be living with HIV compared to other adults 4, 5.
Evidence of the disproportionate epidemiological burden that members of key populations shoulder has been met with important policy developments and funding commitments. In 2014, the Global Fund to Fight AIDS, Tuberculosis and Malaria launched the Key Populations Action Plan, reflecting its commitment to help meet their HIV prevention, care and treatment needs and rights 6. That same year, WHO released consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations 3. These guidelines were updated in 2016 to reflect the urgent call to treat all individuals regardless of CD4 count and to provide pre‐exposure prophylaxis (PrEP) to those “at substantial risk” 7. Additional global implementation guidance and programmatic tools soon followed to support key population programme design and scale up 8-12.