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Key Populations Essential to Realize An AIDS-Free Generation

Workling on the Phnom Penh riverside.As we commemorate World AIDS Day this year, let’s take a moment to remember how far we’ve come, and where we must go. There are currently 35 million people living with HIV worldwide, and 13.6 million of those people are receiving antiretroviral therapy. New HIV infections continue to decline each year, with 2.1 million in 2013, which was 38 percent lower than in 2001. However, over 4,000 people continue to die from AIDS each and every day.

In accordance with the immense toll that HIV and AIDS have taken on the world, the U.S. Government established the U.S. President’s Emergency Plan for AIDS Relief [PDF 4MB] (PEPFAR) in 2003 as the single largest commitment by any nation to combat a single disease. Since then, working closely with many partners, PEPFAR has supported lifesaving antiretroviral therapy for more than 6.7 million men, women and children. As a key implementing agency of PEPFAR, USAID has made significant contributions to this remarkable progress. But, together, we have more work to do to finish the job.

UNAIDS Exit Disclaimer has identified the 90-90-90 targets by 2020. These milestones aim to have 90 percent of people living with HIV know their status, 90 percent of people who know their status receive treatment, and 90 percent of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious. In order to achieve these goals and have a lasting response to this epidemic, we must examine what is required to sustain HIV treatment for decades to come.

INDIA-HEALTH-AIDS

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

 

The vision for the next phase of PEPFAR is partnering to deliver an AIDS-free generation with sustainable results.However, a sustainable response to this epidemic requires intensified action to address major ongoing challenges such as health care financing, health systems and new technologies for treatment and prevention. And there is a special need for increased attention to the human rights of key affected populations. These include sex workers, men who have sex with men, transgender persons and persons who inject drugs.

The high vulnerability of key populations to HIV is disturbing. Compared to the general population, sex workers are 14 times more likely to be infected with HIV; men who have sex with men are 19 times more likely to be infected; and the limited data we have on transgender women suggest that they are 49 times more likely to be infected with HIV. Equally unsettling are the global estimates that the number of people living with HIV who inject drugs range from over 1 million to slightly less than 4 million people.

Barriers to essential services prohibit these figures from coming down. Stigma and discrimination, violence, criminalization, bad or ineffective policies, and opposition to civil society engagement present real challenges. One of the most egregious barriers is the lack of acknowledgement by governments and other leaders that key populations even exist and/or are underserved. As I have observed over the years, the most insidious form of oppression is to ignore a people.

Fortunately, that pessimistic view is tempered by the knowledge that these barriers can be overcome. We know from experience that effective programs can reach key populations with high quality, effective services, and that key populations infected with HIV can be linked to the care and treatment services that they desperately need. On Thursday, Dec. 4, we will highlight the importance of key populations in the HIV epidemic at the D.C. launch Exit Disclaimer of USAID’s PEPFAR-funded LINKAGES project.

The U.S. Government’s official theme for World AIDS 2014 is Focus, Partner, Achieve: An AIDS-free Generation. This theme captures the core elements of what is needed to reach this goal, which is outlined in the PEPFAR Blueprint. We must deliver the right thing, in the right place and at the right time. This means focusing on the highest impact interventions, bringing them to scale in key geographic areas and among the most vulnerable populations, including men who have sex with men, sex workers, injecting drug users, and transgender persons.

On this World AIDS Day, nearly 35 years into the epidemic, I am extremely proud of our collective progress. But, while an AIDS-free generation is within our reach, we must not stop until it becomes our reality.