HIV/AIDS, Reaching High-Risk Populations

Twenty-five years into the global HIV/AIDS epidemic, HIV infection rates remain alarmingly high, with more than 4 million new infections every year. Despite the rapid global spread of HIV, most people in both industrialized and developing countries are at relatively low risk of HIV infection. Comprehensive prevention programs directed at all segments of the general population can help to improve awareness, change social norms, reduce stigma and discrimination, promote less risky behavior, and reduce new infections. However, careful analysis of the sources of new infections in subpopulations is essential in order to focus relevant interventions and maximize their impact. A combination of risk avoidance (abstinence, mutual fidelity) and risk reduction (reduction in the number of sexual partners, treatment of sexually transmitted diseases, correct and consistent condom use, male circumcision, and needle exchange) have proven to be successful all over the globe.

Effective targeted prevention interventions can also lower the number of patients requiring costly drug treatments and boost the sustainability of expensive antiretroviral therapy (ART). At the same time, successful ART makes prevention more acceptable and helps in reducing stigma and discrimination.

To control HIV infections, the focus should be on the populations experiencing the highest rate of infections—often referred to as “high-risk populations,” “most at risk populations,” or “most vulnerable populations” (MVPs). Interventions tailored to specific populations reach a smaller audience than those aimed at the general population, yet they have the possibility to make a disproportionate impact on the course of the epidemic.

[Page 443]MVPs are a relatively smaller segment of the general population that is at higher than average risk of acquiring or transmitting HIV infections. They include discordant couples, sex workers (SWs) and their clients, injection drug users (IDUs) and other drug users, men who have sex with men (MSM), individuals in the armed forces, prisoners, and children of sex workers. A larger group of MVPs, especially in high-prevalence countries, may include HIV-positive pregnant women, sexually active and out-of-school youth, minority populations, migrant and displaced persons, and large populations of women.

There are compelling reasons to reach MVPs:

• They are often marginalized, criminalized, victimized, and discriminated against by law enforcement agencies as well as the general population. As a result they are difficult to reach and have poor access to relevant public health and other services.
• Segmentation of the various subpopulations allows for more specific, appropriate, and effective interventions.
• There are numerous proven interventions that can control the epidemic in IDUs, SWs, and MSM.