WB studies call for better prevention and treatment for sex workers, drug users

In commemoration of World AIDS day this year, two new World Bank studies have urged governments and their development partners to provide better prevention, care and treatment services for sex workers and people who inject drugs as an important step toward ensuring a world free of AIDS.

World AIDS Day is commemorated on December 1st each year.

A press release by the Bank on Thursday to the Ghana News Agency, said the studies were the second and third in a three-part series on key populations at higher risk in low- and middle-income countries.

It said in June 2011, the World Bank and partners launched the first study, which focused on men who had sex with men.

The release cited David Wilson, World Bank Global AIDS Programme Director as saying: “In many countries, sex workers, people who inject drugs, and men who have sex with men remain marginalized in society and vulnerable to HIV.”

“Even in countries with epidemics in the general population, these groups are disproportionately affected by the epidemic. Effective interventions not only protect members of these marginalized communities, but also make a major contribution to averting a wider epidemic,” the release stated.

The Bank said sex workers, people who inject drugs, and men who have sex with men were at significantly higher risk of HIV infection than other groups in low- and middle-income countries.

It said according to a recently released United Nations AIDS report, among countries with generalized epidemics, HIV prevalence is consistently higher among sex workers in the capital city than in the general population, at around 23% and around three million of the 16 million people worldwide who use drugs are living with HIV.

“HIV infection among men who have sex with men in capital cities is on average 13 times higher than in the general population,” the World Bank release added.

The release observed that the World Bank, United Nations Population Fund (UNFPA), and John Hopkins Bloomberg School of Public Health collaborated on the sex workers study and the Global HIV Epidemic among men Sex Workers, which found that a community empowerment approach to HIV prevention, treatment, and care was cost-effective, with significant projected impact on HIV incidence among sex workers and transmission beyond the sex worker community.

It said according to the study, globally, HIV disproportionately affected sex workers in low and middle-income countries and that the overall HIV prevalence among female sex workers was 11.8%, with the prevalence in Sub-Saharan Africa at 36.9%.

The release stated that across all regions, prevalence among female sex workers was 13.5 times the overall HIV prevalence among the general population of women ages 15-49.

“Sex workers continue to face heightened social and structural vulnerabilities to HIV. The study emphasizes the central importance of adopting a rights-affirming, empowerment-based approach to scale up comprehensive HIV services, and addressing stigma, discrimination, and violence against sex workers.”

It said the World Bank, Future Group and Johns Hopkins Bloomberg School of Public Health study on the Global HIV Epidemic among People Who Inject Drugs, found that although HIV prevalence was significantly higher among people, who inject drugs than in the general adult population and that the availability of antiretroviral treatment and other key prevention interventions, was generally inadequate.

According to the press release the researchers predicted that continuing to specifically target these groups with needle and syringe programmes, medically assisted therapy and HIV counseling and testing, as well as increased access to antiretroviral treatment, could avert thousands of infections from 2012-2015, including 1,300 in Kenya, 4,130 in Pakistan, 1,570 in Thailand, and 3,900 in Ukraine.

The release held that interventions for people who inject drugs were cost-effective or highly cost-effective investment choices across the breadth of the global epidemic.

It quoted Farley R. Cleghorn, Futures Chief Technical Officer and Team Leader for the study as saying: “The ability to rapidly and cost-effectively intervene in HIV transmission with currently proven interventions holds the most promise among people who inject drugs worldwide”.

It said the study on Global HIV Epidemics Among Men Who Have Sex with Men: Epidemiology, Prevention, Access to Care and Human Rights, found that achieving high rates of coverage of HIV prevention and treatment services among men who have sex with men had a significant positive impact on the overall trajectory of a country’s HIV epidemic.

The release said less than one in ten men who have sex with men worldwide have access to basic HIV/AIDS prevention, care, and treatment services.

It said the authors of that study recommended a comprehensive package of essential services, including risk-reduction counseling, distribution of condoms and other safe-sex measures, community-based prevention efforts, HIV testing, and increased use of antiretroviral therapy treatment.

The release posited that the report highlighted the need for the decriminalization of the behavior of men who have sex with men, the institution of anti-homophobia policies, increased education of healthcare workers, and the reduction of stigma in healthcare situations.