AIDS 2016 Focus on Legal Barriers to HIV Services For At-Risk Groups

At the 21st International AIDS Conference (AIDS 2016) in Durban, researchers and community representatives discussed the impact of discriminatory laws and policies in many parts of the world that hinder access to HIV prevention, treatment, and care for the populations most at risk of HIV infection -- men who have sex with men, transgender people, sex workers, people who inject drugs, and prisoners.

The latest data from UNAIDS show that these vulnerable populations account for more than one-third of all new HIV infections globally. Compared to the general population: transgender people are 49 times more likely to be living with HIV; men who have sex with men and people who inject drugs are each 24 times more likely to become infected with HIV; sex workers are 10 times more likely to become infected; and prisoners are five times more likely to be living with HIV.

"We will not end AIDS without addressing the needs of the most vulnerable individuals and communities, yet far too many are currently being left behind," said Chris Beyrer, AIDS 2016 International Chair and President of the International AIDS Society. "Protecting human rights is not just a moral issue, it is a scientific issue. Research presented at this conference will demonstrate that exclusion and discrimination help fuel the spread of HIV."

Beyrer recently served on a special Johns Hopkins University-Lancet Commission on Drug Policy and Health. He was lead author of the Commission's final report, published in March 2016 in advance of the UN Special Session on the World Drug Problem. The report concluded in part that drug laws intended to protect have instead contributed to disease transmission, discrimination, lethal violence, and forced displacement, and have undermined people's right to health.

"Dealing effectively with HIV will require our communities and societies to break down longstanding prejudice, hatred, and ignorance," said Justice Edwin Cameron of the Constitutional Court of South Africa. "Only when scientific advances are matched by social and cultural progress can this epidemic truly be contained."

Other press conference speakers included Nigerian LGBT activist Bisi Alimi, President of the Global Network of Sex Work Projects Pye Jakobsson, and Chair of the Asia Pacific Transgender Network Abhina Aher. In addition, Frances Cowan of University College London discussed the results of one of the largest randomised trials ever conducted among female sex workers:

SAPPH-IRe intervention empowers female sex workers: The SAPPH-Ire trial was conducted among female sex workers (FSW) embedded within Zimbabwe's National FSW Programme, Sisters, which provides sex-worker friendly services, free HIV testing, referral to government health services for ART, contraception, condoms, management of sexually transmitted infections, health education, and legal advice, all supported by peer educators.

In addition to the services provided by Sisters, SAPPH-IRe sites provided intensified community mobilization, onsite ART and PrEP, mobile phone SMS reminders to promote repeat HIV testing, and community-based adherence support to improve engagement with enhanced prevention and care. The primary outcome was the proportion of all FSW with detectable viral load (VL>1000 copies/ml) after 21 months. A baseline survey was completed in November 2013 (n=2,722 FSW, 57.5 percent HIV-positive, 50.5 percent HIV-positive and with viral load >1000 copies /ml) and a separate endline survey was conducted in April 2016.

Secondary outcomes showed more than double the number of HIV tests at SAPPH-IRe sites compared to Sisters (2,606 vs. 1,151) and increased programme activity for all services, including onsite ART and PrEP initiations.