IMPLEMENTING HIV AND STI PROGRAMMES WITH KEY
POPULATIONS
Dr. Alexandr Kossukhin,
HIV Programme Specialist
United Nations Population Fund,
Regional Office for Eastern Europe and Central Asia
Delivering a world where every pregnancy is wanted,
every childbirth is safe and every young person's
potential is fulfilled.

UNAIDS 90-90-90 STRATEGY
HIV treatment is a critical tool towards ending the epidemic. HIV
treatment prevents illness, death and averting new infections
Treatment targets by 2020
90%
diagnozed
90% on
treatment
90%
virally
suppress
ed

PROPORTION OF CD4 CELL COUNTS <350 REPORTED FOR HIV
CASES OLDER THAN 14 YEARS, DIAGNOSED IN 2012
(DATA OF ECDC AND WHO EURO)
75
53
0 10 20 30 40 50 60 70 80
Albania
Armenia
Azerbaijan
Belarus
Bosnia and Herzegovina
Georgia
Kazakhstan
Kosovo
Kyrgyzstan
FYRMacedonia
Moldova
Montenegro
Serbia
Tajikistan
Turkey
Turkmenistan
Ukraine
Uzbekistan
PEOPLE ARE NOT MUCH MOTIVATED TO KNOW THEIR HIV STATUS

PROPORTION OF CD4 CELL COUNTS <350 REPORTED FOR HIV
CASES AMONG MSM, DIAGNOSED IN 2012
(DATA OF ECDC AND WHO EURO)
78
46
0 10 20 30 40 50 60 70 80 90
Albania
Armenia
Azerbaijan
Belarus
Bosnia and…
Georgia
Kazakhstan
Kosovo
Kyrgyzstan
FYRMacedonia
Moldova
Montenegro
Serbia
Tajikistan
Turkey
Turkmenistan
Ukraine
Uzbekistan

ESTIMATED NUMBER OF ADULTS AND CHILDREN
NEWLY INFECTED WITH HIV2013
Middle East & North Africa
25 000
[14 000 – 41 000]
Sub-Saharan Africa
1.5 million
[1.3 million – 1.6 million]
Eastern Europe & Central
Asia
110 000
[86 000 – 130 000]
Latin America
94 000
[71 000 – 170 000]
Caribbean
12 000
[9400 – 14 000]
Total: 2.1 million
Sub-Saharan Africa: 1.5 million
Eastern and Southern Africa (ESA) Region: 1.1 million
Asia and the Pacific
350 000
[250 000 – 510 000]
North America and Western and Central Europe
88 000
[44 000 – 160 000]
5

NEWLY DIAGNOZED HIV INFECTIONS BY COUNTRY
(DATA OF ECDC, WHO EURO, 2012)
0
20
40
60
80
100
120
140
160
2006 2007 2008 2009 2010 2011 2012
Serbia
Albania
Bosnia and Herzegovina
Montenegro
FYR Macedonia
Linear (Serbia)
Linear (Albania)
Linear (Bosnia and Herzegovina)
HIV spread in Balkan countries is low, but trend to its increase is there

Between 40% and 50%
of all new HIV infections
among adults
worldwide occur among
people from key
populations and their
immediate partners
0 50 100 150 200
Albania
Armenia
Azerbaijan
Belarus
Bosnia
Georgia
Kazakhstan
Kosovo
Kyrgyzstan
Makedonia
Moldova
Serbia
Tajikistan
Turkey
Turkmenistan
Ukraine
Uzbekistan
0 100 200 0 100 200 300
HIV PREVALENCE AMONG KEY POPULATIONS PER 1000 IN COUNTRIES
OF EECA REGION (DATA OF NATIONAL REPORTS OF IMPLEMENTATION
OF UNGASS DECLARATION (2012-2013)
Sex workers MSM PID

KEY POPULATIONS GUIDANCE
• WHO Consolidated Guidelines on HIV, Prevention, Diagnosis,
Treatment and Care for Key Populations
• SWIT, MSMIT, DUIT, TRANSIT (by WHO, UNFPA, WB and
others)
• Global Commission on HIV and the Law (by UNDP and others)
• World Bank/JHSPH/UNFPA/UNDP/UNODC Global HIV
Epidemics series
• UNAIDS Guidance Note on HIV and Sex Work
Focusing on populations with higher risk of exposure to HIV: sex workers,
MSM, transgenders, prisoners and PID is a key to tackle the epidemic

The guidelines addresses:
• comprehensive package of
• clinical interventions critical
enablers
• service delivery
• decision-making,
• planning and monitoring and
evaluation
WHO CONSOLIDATED GUIDELINES ON HIV, PREVENTION, DIAGNOSIS,
TREATMENT AND CARE FOR KEY POPULATIONS

Summary of
recommendations
ALL KEY POPULATIONS
• Condoms and condom-compatible lubricants
• Post Exposure Prophylaxis (PEP)
• Interventions to fix problems with alcohol and substance abuse
MEN WHO HAVE SEX WITH MEN
• Pre-Exposure Prophylaxis (PrEP )
PEOPLE WHO INJECT DRUGS
• Sterile injecting equipment
• Opiate substitution treatment
• Naloxone
PREVENTION OF HETEROSEXUALLY ACQUIRED HIV IN MEN
• Voluntary medical male circumcision (VMMC)
HIV PREVENTION

HEALTH SECTOR INTERVENTIONS:
HIV TESTING AND COUNSELLING. TREATMENT AND CARE
• Voluntary HTC (including community-based) linked to
prevention, treatment and care;
• Anti-retroviral treatment (ART);
• Prevention of mother to child transmission (PMTCT);
• TB prevention, screening and treatment services;
• Hepatitis B and C prevention, screening and treatment
services ;
• Screening and management of mental health
Summary of
recommendations

SEXUAL AND REPRODUCTIVE HEALTH
• Screening, diagnosis and treatment of STIs
• Cervical cancer screening
• Contraception and pregnancy care
• Range of reproductive options and full, pleasurable
sex lives
• Abortion laws and services should protect the health
and human rights of all women (WHO accent)
Summary of
recommendations

CRITICAL ENABLERS
Summary of recommendations
• Laws, policies and practices - decriminalization of behaviours /
elimination of the unjust application towards:
- drug use/injecting,
- sex work,
- same-sex activity and
- non-conforming gender identity
• Eliminate stigma, discrimination and violence against key populations;
• Health services should be made available, accessible and acceptable;
• Package of interventions to enhance key populations;
• Communities empowerment;
• Preventing and addressing violence against key populations in
partnership with key population- led organizations .

KEY POPULATIONS ARE RIGHTS HOLDERS. TO INSURE THAT
CRITICAL ENABLERS ARE REALIZED KEY POPULATIONS
MUST BE EPOWERED TO CLAIM THEIR RIGHTS
• Human rights are fundamental. People
are inherently entitled to them;
• Human rights are universal, indivisible
and interdependent and related;
• Human rights are egalitarian they are
the same for everyone
Standards of human behavior that are regularly protected as legal rights
in international law include
• Righto highest standards of health care,
• Right to decide the timing, number and spacing of one’s children.
• Freedom from discrimination,
• Fight to fair trial, ,
• Freedom from tortures
• Freedom of speech,
• Freedom of thought, conscience and religion,
• Freedom of movement and so on.

• Reaching out to key populations
• Condom and lubricant programming: forecasting, quality assurance
and distribution
• Supporting safer behavior (including SRH care seeking behaviors and
in particular;
• STI health care seeking behavior as a community norm;
• Generating demand and implementation of HTC through mobile
outreach;
• Connecting key populations to health care and supportive services;
• Insuring observance of human rights
• Feedback on the quality of services from the point of clients’
satisfaction;
• Training duty bearers (health care providers, social workers, law
enforcement bodies etc.)
KEY POPULATIONS ARE PARTNERS
EMPOWERING KEY POPULATIONS TO PROTECT THEIR HEALTH:
UNIQUE ROLES OF COMMUNITIES

IMPLEMENTING COMPREGENSIVE
PROGRAMMES JOINTLY

Human rights based approach works
Community-empowerment-based responses to HIV in sex
workers were consistently associated with significant
reductions in HIV and STIs, and increases in condom use.
-- Lancet series 2014
• Securing adequate financial resources for sustaining and
further improving the national responses through continuity of
outreach services and partnership with civil society is crucial;
• Some countries made a way to amend the social contracting
and NGO funding legislations and ensured sustainability of
NGOs engagement in the situation of decreased international
support to NGOs;
• Local authorities have a particular role to cooperate with
NGOs

THANK YOU!
• Addressing HIV is integral to UNFPA’s goals of achieving universal
access to sexual and reproductive health, and realizing human rights
and gender equality
• UNFPA promotes integrated HIV and sexual and reproductive health
services for young people, key populations, and women and girls,
including those living with HIV.
• UNFPA supports the empowerment of these populations to claim their
human rights and access the services they need
• All of UNFPA’s work on HIV is done by engaging and empowering the
communities it is mandated to serve.