Keerti Gedela

Presenters from the WHO, Global Fund, IAS and the community discussed the new WHO guidelines for HIV, hepatitis and STIs for key populations. The focus was on strengthening people-focused services tailored to key populations, integrating STIs and Hepatitis, integral involvement of peer navigators and tackling structural barriers and inequality.

Meg Doherty highlighted UNAIDS data, that 70% of new HIV infections are in key populations (KPs), and the need to focus on person-focused KP services. A primary focus was addressing structural barriers that KPs face. Prof Kamarulzaman highlighted the high-risk of HIV acquisition for KPs e.g. people who inject drugs have a 35 times higher-risk. She calls for people-focused social innovations and the need to involve KPs in collaborative research and service development. She highlighted impactful and innovative work from settings in the Asia-Pacific region. Virginia MacDonald outlined methodology in developing the new WHO guidelines, which aim to provide clarity across broad areas and recommend integrated HIV, Hepatitis and STI services. Methodology included reviewing evidence from existing guidelines and gaps in data and qualitative research from all WHO regions involving all KP groups. Recommendations include removing punitive laws and reducing stigma. Guidance updates include caution regarding counselling-based behavioural interventions; early treatment of hepatitis C for people at continued risk and include revised recommendations for service delivery and the use of online interventions. A panellist from PEPFAR acknowledged the new guidelines would shape their strategy. Notably, including a new sustainability framework focusing on KP-led community leadership and tackling structural barriers.

The new WHO guidelines provide an essential framework for the global community to progress toward the UNAIDS 95-95-95 targets and to lever action. Topics discussed varied from key epidemiology, social and political barriers, and current game-changing drug technology of CAB LA as PrEP. Despite the focus on tackling structural barriers, there was little discussion on how to enable this within conservative environments and settings with punitive laws. Additionally, the new WHO guidelines require robust evidence, however, the lack of robust data from some LMICs may restrict a wider context of the challenges these settings face.