The argument for HIV programming for at-risk populations in Africa

Why target at-risk populations in Africa.pdf

The Bridge Project is a new Africa-India-Asia learning network. Their session at the 2012 AIDS Conference translated lessons from the Indian experience of scaling-up HIV interventions for key populations into the African context.

Dr Stephen Moses from STRIVE partner group KHPT titled his presentation: "Responding to the HIV epidemic in Africa: How important is HIV prevention programming among most at-risk populations?" Answering his own question, Dr Moses emphasised that key affected populations, such as sex workers and men who have sex with men, are crucial in driving generalised epidemics (as in many African countries) as well as concentrated epidemics (as in India).

Challenging common assumptions

Existing methods, such as modes of transmission analysis (MOT), tend to under-estimate the significance of key affected populations - female sex workers, men who have sex with men and injecting drug users - because:

  • numbers are under-estimated, particularly of clients
  • many women involved in transactional sex do not identify as "sex workers"
  • taking a "current snapshot" focuses on "current" sources of risk, rather than where an infection may have originated. 

Infection this year within a monogamous couple, for example, shows up in the data as "general population". But, traced upstream, the majority of new cases of infection in virtually every country can be attributed to contact with one of these key affected populations.

When it comes to shaping policy and programmes, factors other than evidence play an important part. Politicians generally do not like dealing with groups on the margins of society. Public opinion is often prejudiced against sex workers, drug users and men who have sex with men. It is important, therefore, to do advocacy with policy makers and decision makers.

Some practitioners fear that targeted programming will increase stigma. However, experience shows the opposite. "When you work openly with these groups," Dr Moses explained, "other people recognise that they are important. They become empowered. You can change the views of society."

AIDS 2012 session

Other speakers at the Bridge Project session:

  • Ms. Rebecca Dirks, Senior Technical Officer, Global Health Population and Nutrition, FHI 360
  • Ms. Shanti Conly, Team Leader, HIV Prevention; USAID Office of HIV/AIDS, Washington
  • Dr.David Allen, Senior Program Officer, Bill & Melinda Gates Foundation
  • Dr. Timothy Mastro, Mastro Director of Global Health, Population and Nutrition, FHI 360
  • Dr. Gina Dallabetta, Senior Program Officer, Bill & Melinda Gates Foundation

Experiences of integrating lessons from India were presented by:

  • Prof John Idoko, Director General, National Agency for the control of AIDS, Nigeria
  • Dr. Richard Amenyah, Director of Technical Services, Ghana AIDS Commission
  • Dr. Yogan Pillay, Deputy Director General, National Department of Health, South Africa
  • Dr. Joshua Kimani, Lecturer-UNITID and Clinical Director, Kenya AIDS Control Project


MSM: men who have sex with men

FSW: female sex workers

IDU: injecting drug users

CHS: casual heterosexual sex

PBS: polling booth surveys

FTFI: face-to-face interviews

Learning exchange

"Africa globally leads the way for scaled up HIV care and treatment programmes in generalised epidemics ... India has extensive experience in implementing and scaling up prevention interventions in concentrated epidemics. An interactive and focused exchange of learnings can lead to increased knowledge and improved practical skills, with an emphasis on addressing key challenges."

from The Bridge Project brochure

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