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IAS Conference - 22nd July 2014

IAS Conference - 22nd July 2014. Gottfried Hirnschall Director, HIV Department, WHO, Geneva.

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IAS Conference - 22nd July 2014

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

  2. Five key populations (KP) • 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

  3. Why these five KP? • Up to 50% of new HIV infections are in 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

  4. Why consolidated KP guidelines? • 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

  5. What's in the guidelines? WHAT TO DO? • Prevention • Testing • Treatment & care • Critical enablers • 'Essential' packages for specific KP Key Interventions Service delivery & implementation Decision making, planning and M&E 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

  6. Health-sector interventions • 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

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

  8. Critical enablers In Portugal, between 2000- 2008,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

  9. Take-home messages • "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

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