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Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations

by Public Health Update

Overview

The Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations outline a public health response for 5 key populations (men who have sex with men, trans and gender diverse people, sex workers, people who inject drugs and people in prisons and other closed settings). They present and discuss new recommendations and consolidate a range of recommendations and guidance from current WHO guidelines.

Particularly for key populations, social, legal, structural and other contextual factors both increase vulnerability to HIV, viral hepatitis and STIs and obstruct access to health and other essential services. These guidelines highlight the critical importance of addressing structural barriers in all settings as a priority.

In most countries, inadequate coverage and poor quality of services for key populations continue to undermine responses to HIV, viral hepatitis and STIs. All countries should prioritise reaching key populations and supporting key population communities to lead the response and provide equitable, accessible and acceptable services.

In most countries, inadequate coverage and poor quality of services for key populations continue to undermine responses to HIV, viral hepatitis and STIs. All countries should prioritise reaching these key populations and supporting key population communities to lead the response and provide equitable, accessible and acceptable services to these groups.

These guidelines focus on the above five groups, originally defined as “key” in the HIV response across the three infectious disease areas. This is for the following reasons.

  • The structural barriers which limit the five key populations’ access to HIV services also limit their access to viral hepatitis and STI services.
  • HIV risk behaviours such as condomless sex and unsafe injecting, which are in general more common in key populations, are also among those that increase the risk of acquiring viral hepatitis and STIs.
  • Many of the interventions recommended for HIV prevention also have an impact on transmission of viral hepatitis and STIs.
  • Particularly for key populations, social, legal, structural and other contextual factors both increase vulnerability to HIV, viral hepatitis and STIs and obstruct access to health and other essential services. These guidelines highlight the critical importance of addressing structural barriers in all settings as a priority.

Guidelines principles

These guidelines are developed with the following principles:

  • human rights;
  • gender equality;
  • equity and inclusion;
  • medical ethics;
  • universal health coverage;
  • evidence-based public health;
  • key population community-led response.

Summary of essential health and enabling recommendations

Essential for impact: enabling interventions

  • Removing punitive laws, policies and practices
  • Reducing stigma and discrimination
  • Community empowerment
  • Addressing violence

Essential for impact: health interventions
Prevention of HIV, viral hepatitis and STIs

  • Harm reduction (needle and syringe programmes (NSPs), opioid agonist maintenance therapy
  • (OAMT) and naloxone for overdose management)
  • Condoms and lubricant
  • Pre-exposure prophylaxis (PrEP) for HIV
  • Post-exposure prophylaxis (PEP) for HIV and STIs
  • Prevention of vertical transmission of HIV, syphilis and HBV
  • Hepatitis B vaccination
  • Addressing chemsex

Diagnosis

  • HIV testing services
  • STI testing
  • Hepatitis B and C testing

Treatment

  • HIV treatment
  • Screening, diagnosis, treatment and prevention of HIV-associated tuberculosis (TB)
  • STI treatment
  • Hepatitis B and hepatitis C treatment

Essential for broader health: health interventions

  • Anal health
  • Conception and pregnancy care
  • Contraception
  • Gender-affirming care
  • Mental health
  • Prevention, assessment and treatment of cervical cancer
  • Safe abortion
  • Screening and treatment for hazardous and harmful alcohol and other substance use
  • TB screening and prevention

Download: Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations


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