Targeting At-risk and Key Populations
State of the epidemic
The 2017 UNAIDS data report reported that a worldwide scale-up of antiretroviral therapy led to a steep 48% decline in AIDS-related deaths, plummeting to 1.0 million in 2016 from nearly 2 million in 2005. The number of children (aged 0–14 years) dying of AIDS-related illnesses has nearly halved in since 2010. There have been sharp reductions in new HIV infections among children, owing largely to an increased access to pediatric antiretroviral therapy. The report also acknowledged collaborative global effort that has strengthened and prevented the transmission of HIV.
However, we have a long way to go evidenced by gaps in the 90–90–90 continuum that are higher for women, young children and key populations. What has become increasingly clear is the need for nuanced solutions that target specific at-risk populations. Recent trends reveal that in high-prevalence settings, young women are particularly susceptible to HIV infection. According to the report1, young women in eastern and southern Africa (aged 15–24 years) accounted for 26% of new HIV infections in 2016 despite making up just 10% of the population. In lower prevalence settings, the majority of HIV infections occur in those who inject drugs, sex workers, transgender people, prisoners, and gay men and other men who have sex with men—and their sexual partners.1 In India, women and children are at high risk, not just impacting the duration of their lives but their quality of living. Moreover, women and children who live in rural areas are disproportionately affected. In these settings, women have little to no negotiating and decision-making power within the family unit and often do not seek care for fear of seeming self-indulgent. Furthermore, children are largely unaware of their health status in an attempt by parents and guardians to avoid bullying and other forms of social stigmatization and marginalization. India is home to the largest number of orphans of the HIV epidemic (Mothi, Lala and Tappuni, 2016). For years, the diagnosis of the disease was perceived as a death sentence. This lack of awareness on prevention and treatment combined with a fear of discrimination creates complex barriers to timely, effective care.
According to a report in The Lancet, late diagnosis in key populations counteracts the potential effects of treatment as prevention in the general population. Funding is a concern as well with resources falling short of global commitments.
Developing targeted solutions
TeachAids noticed the plight of HIV-affected children and understood the critical need for material that was tailored to reach their social and cultural environment. All too often, prevention and treatment methods are extrapolated from successes in European countries and the USA, whose cultural histories and practices are far removed from that in the developing world. Countries and the various populations within them need solutions that consider their personal motivations and challenges. Earlier this year, the teaching team at TeachAids guided dozens of Stanford graduate and undergraduate students in embarking on a challenge to create and circulate a new TeachAids curriculum for a country in need that was assigned to them. The research considered the state of the HIV epidemic in their target country, analyzed the barriers to circulating effective health education, and the use of practical implementation pathways. Working on the challenge helped the teams develop contextualized solutions that are more likely to yield positive results. In June, three students interned at TeachAids, lending innovative perspectives and unique solutions to the challenge of delivering high quality, transformative education to young children across the world.
Understanding the country-specific barriers to seeking care will be immensely important in achieving the ambitious 90-90-90 treatment target. TeachAids is engaged in sustained learning and exceptional research that informs educational material across populations. We believe that this provides the best chance of successfully improving health and quality of life outcomes.