Key Populations

Key populations in the health response are populations that are often subject to discrimination, criminalization and human rights abuses, thereby severely limiting their ability to access health services. In some settings and populations, such as in prisons and among some migrant and displaced populations, risks of HIV, TB, malaria and other diseases are also high, while access to services is frequently poor. There is now strong recognition that major epidemics cannot be ended without greater attention to key populations in all epidemic settings. This includes addressing social, legal and cultural barriers to accessing HIV and other health services, and consistent inclusion and participation by key populations in policy development, health governance and programming.

HIV:  Key populations include men who have sex with men, sex workers, people who inject drugs, transgender people, people in prisons and other closed settings, and their partners. People living with HIV are also part of the key populations. In 2023[2], median HIV prevalence among the adult population (ages 15–49) was 0.8% globally. However, because of marginalization, discrimination and in some cases criminalization, median prevalence was higher among certain groups of people.

• 2.3% higher among young women and girls aged between 15 and 24 in eastern and southern Africa
• 7.7% higher among gay men and other men who have sex with men
• 3% higher among sex workers
• 5% higher among people who inject drugs
• 9.2% higher among transgender people
• 1.3% higher among people in prisons.

The risk of acquiring HIV is

• 35 times higher among people who inject drugs than adults who do not inject drugs.
• 30 times higher for female sex workers than adult women of the general population.
• 28 times higher among gay and bisexual men and other men who have sex with men than adult men of the general population.
• 14 times higher for transgender women than adult cisgender women of the general population.

TB:  Key populations may include people in prison and people in other closed settings, people living with HIV, migrants, refugees and indigenous populations.

Malaria:  While the concept of key populations in the malaria response is relatively new, and less understood than for HIV or TB, refugees, migrants, internally displaced people and indigenous populations are all at greater risk of malaria transmission, as they have decreased access to care and are often marginalized.

The Global Fund’s technical Brief HIV Programming at Scale for and with Key Populations describes the essential interventions and approaches for key populations that should be incorporated in HIV funding requests. It is based on the latest normative and implementation guidance, including the World Health Organization (WHO) Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention, Diagnosis, Treatment and Care for Key Populations (2022) and other guidance documents.

When preparing funding requests and interventions to meet the needs of key populations, Country Offices are strongly encouraged to review the technical brief guidance in detail. This Introduction outlines why key populations are especially vulnerable to HIV. Section 2 examines the HIV Program Essentials and the prioritized interventions in the HIV Information Note, provides details relevant to key populations, and considers service delivery approaches. Section 3 shows how to incorporate key population interventions into Global Fund proposals. It is structured around three of the Global Fund Strategy’s objectives: 1) maximizing people-centred integrated systems for health, 2) maximizing the engagement and leadership of most-affected communities (including key populations), and 3) maximizing health equity, gender equality and human rights.

Key messages from the technical brief:

[2] Global HIV & AIDS statistics — Fact sheet, UNAIDS

Additional guidance to support this area of work are also available through a number of resources listed below:

• Global Fund Technical Brief: Removing Human Rights related barriers to HIV Services

• Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions

• Implementing Comprehensive HIV and STI Programmes with Men Who Have Sex with Men

• Implementing Comprehensive HIV and STI Programmes with Transgender People

• Implementing comprehensive HIV and HCV Programmes with people who inject drugs

• Adolescent and Young Key Populations Toolkit

• International Guidelines on Human Rights and Drug Policy

• Issue Brief #1: Enabling Legal Environments, Including Decriminalization for HIV Responses

• Issue Brief #2: The Role of The Judiciary in The HIV Response

• Issue Brief #3: Regional Spaces for HIV Responses

• Issue Brief #4: Safe and Open Civic Spaces for HIV Responses

• Strengthening Civic Space and Civil Society Engagement in the HIV Response

• Technical brief: HIV prevention, testing, treatment, care and support in prisons and other closed settings: a comprehensive package of interventions

• UNDOC, Technical Brief: Transgender People in Prison and Other Closed Settings