Definitions

Key populations at increased risk of HIV: People are said to be at increased risk of acquiring the HIV infection if what they are doing, or what they might do if placed in a facilitating situation, is associated with a high risk of HIV transmission. Examples of those population groups are injecting drug users (IDU), male and female sex workers and men who have sex with men.

Vulnerable groups: People are said to be in a state of vulnerability if their living conditions are prone to shifting factors which would place them at risk of contracting HIV. Examples of those groups are young people, women, migrants, long-distance drivers, displaced populations, men in uniform and others.

Importance of working with vulnerable groups and key populations at increased risk of HIV

The HIV epidemic is usually heightened by the transmission of the virus among populations with high-risk behavior, and then propagating to the general populations via so-called bridging groups, depending on the extent and nature of social linkages and networks between these populations. Evidence has shown that expanding awareness, prevention and behavior change interventions among key populations at increased risk of HIV can slow or even curb the epidemic.

Moreover, in low level and concentrated HIV epidemics reaching key populations at increased risk of HIV with appropriate services can be more efficient in identifying PLHIV and thus, can provide an entry point for PLHIV to access care, treatment and support.

Approaches to working with vulnerable groups and key populations at increased risk of HIV

Programmes designed to address vulnerable groups and key populations at increased risk of HIV should ensure a friendly environment to allow the access of those groups to the service. Population-friendly environment entails a non-judgmental attitude provided within a non-stigmatizing service facility, by capable and understanding service providers. It also entails ensuring geographical, financial and procedural accessibility. Applied approaches include:

Peer involvement: Peers are the ones who understand most the needs of their fellows. Interaction between them is facilitated by the sense of belonging to the group and by breaking the barriers of misunderstanding, mistrust and intimidation. In addition, peers can play the role of models for each other.

Outreach: Individuals may not seek certain services for various reasons. These reasons can be personal (e.g. level of awareness, perceptions, trust, etc.), socio-cultural (taboo, stigma), legal, financial, geographical, etc. Outreaching to vulnerable groups and key populations at increased risk of HIV can help transcending those barriers.

Low threshold community-based facilities: Complicated admission procedures and paper work may pose a barrier particularly to risk and vulnerable groups. Low threshold means minimizing the administrative and regulatory requirements for attending to the needs of the service users. Basing those facilities within the communities can improve geographic access and ensure community support.

Self help and support groups: Belonging to a group where members share similar life conditions and problems provides the assurance that one is not alone. Collective thinking and problem solving in the group empowers individuals through having an insight to how others managed their situations. In addition, it helps the group to find solutions suitable for their collective situation.

Services provided to vulnerable groups key populations at increased risk of HIV

Awareness raising and behavior change communication

Counseling and Testing

Supply of prevention material such as condoms and sterile injection equipment

Substitution and maintenance therapy for opiate drug users

STI diagnosis and management

Prevention, diagnosis and management of opportunistic and common co-infections such as TB, Hepatitis B and Hepatitis C

Care, treatment and support for PLWHA and their families

Prevention of mother to child transmission

Referral for secondary and tertiary health care needs and for other types of services as needed

Working with vulnerable groups and key populations at increased risk of HIV in the Eastern Mediterranean Region

Over time, several countries in the Eastern Mediterranean Region have developed successful experiences in addressing vulnerable groups and key populations at increased risk of HIV. Services provided in various countries include outreach education and awareness raising, syringe distribution, condom distribution, HIV testing and counselling, opioid substitution therapy, and others. The comprehensiveness of the services and their level coverage, however, remain a great concern.

WHO/EMRO will support countries to introduce or scale up interventions targeting vulnerable groups and key populations at increased risk of HIV through developing resource material and tools, facilitating exchange of experience within the EMR countries and with other regions, supporting capacity building in the field and providing technical support within the countries, tailored according to their specific needs.

Further information

Most-at-risk-populations

Injecting drug use and prisons

See also: HIV Topic Harm reduction