No one left behind: Increased coverage, better programmes and maximum impact for key populations WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations IAS Conference - 22nd July 2014 Gottfried Hirnschall Director, HIV Department, WHO, Geneva

Men who have sex with men People in prisons and closed settings People who inject drugs Sex workers Transgender populations, with a focus on transgender women Adolescent and adults Five key populations (KP)

Increased HIV risk and vulnerability in all settings Because… Poor access to HIV & other health services Increased stigma and discrimination, incl. in the health sector Subject to punitive laws and hostile legal environment Overlapping risk behaviors Up to 50% of new HIV infections are in KP Why these five KP?

From population-specific to consolidation Complement other guidelines (2013 ARV Guidelines) Update and address gaps, include specific issues for transgender people Along the continuum of care prevention→ diagnosis → linkage → HIV treatment & comprehensive care Why consolidated KP guidelines?

HOW TO DO IT? Service delivery Community approaches Case examples HOW TO DO IT? Service delivery Community approaches Case examples HOW TO DECIDE? Assessing the local situation Decision making and planning Framework for key population specific M&E Key data sources HOW TO DECIDE? Assessing the local situation Decision making and planning Framework for key population specific M&E Key data sources WHAT TO DO? Prevention Testing Treatment & care Critical enablers 'Essential' packages for specific KP WHAT TO DO? Prevention Testing Treatment & care Critical enablers 'Essential' packages for specific KP Service delivery & implementation Decision making, planning and M&E What's in the guidelines?

HIV prevention Comprehensive condom and lubricant programming Behavioural interventions Voluntary medical male circumcision for HIV prevention HIV testing and counselling Sexual and reproductive health Contraception Safe abortion Cervical screening Conception and pregnancy Sexually transmitted infections HIV treatment and care ART Prevention of mother to child transmission (PMTCT) Drug interactions Nutrition ARV related prevention Pre-exposure prophylaxis (PrEP) Post-exposure prophylaxis (PEP) Early initiation of ART Substance use related harm interventions Needle and Syringe Programmes Other drug dependence treatment Overdose prevention and management Prevention and management of co- infections and co-morbidities Tuberculosis Viral hepatitis Mental health Health-sector interventions Existing WHO guidance New WHO guidance WHO guidance under development

PrEP Community based distribution of naloxone HIV and contraception Drug interactions New recommendations

Laws and policies Moving towards decriminalizing the behaviour of KP Age of consent to services Recognition of transgender people in the law Access to justice and legal support for KP Stigma and discrimination Anti-stigma, antidiscrimination and protective policies Provision of “KP friendly services” Training and sensitization of health workers Community empowerment Programmes led by key-population organizations Meaningful participation Violence against key populations Prevention of violence against KP Support for persons experiencing violence Critical enablers In Portugal, between , the annual number of new cases of HIV among PWID fell from 907 to 267 after decriminalization of the possession of drugs In South Africa, through the Health4Men Project health workers have been trained and mentored and clinics gained competence in serving MSM

"Ending the AIDS epidemic" will only be achieved with a renewed focus on KP Guidelines as a trigger of change at global and national level Partnerships between Ministries of Health and KP-led community organisations essential for programme success Take-home messages