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New HIV Guidelines Released by WHO

By Pam Harrison
Medscape Medical News

July 23, 2014 (MELBOURNE, Australia) -- Five groups of people are driving the global HIV epidemic, the World Health Organization (WHO) says in its new guidelines.

Men who have sex with men, sex workers, injection-drug users, transgender people, and people in prisons are among the groups targeted for prevention and treatment efforts.

HIV rates are "going down all over the world, with the exception of key affected populations," Fabio Mesquita, MD, said during a news conference at the 20th International AIDS Conference. Mesquita is the director of the HIV and viral hepatitis program at the Ministry of Health in Sao Paulo, Brazil.

"If we don't address key affected populations, we won't reach our goal of controlling the epidemic by the year 2030," he said.

Recent statistics indicate that men who have sex with men are up to 19 times more likely than people in the general population to be infected with HIV. Female sex workers are up to 14 times more likely to be infected. Transgender women are almost 50 times more likely to be infected.

"In all parts of the world, these populations have compromised access to good [HIV-related] services," said Gottfried Hirnschall, MD, director of the WHO Department of HIV/AIDS.

'Hostile Environment' for People at High Risk

Laws that stigmatize people and penalize sexual orientation drive risky behavior underground, making it hard, if not impossible, for people at high risk for HIV to access HIV prevention and care services, speakers at the news conference explained.

As a consequence of this hostile environment, rates of new HIV infections are increasing in all these groups, but especially in men who have sex with men, a group in which "explosive epidemics" of HIV are occurring in many parts of the world, Hirnschall said.

It's estimated that up to 50% of all new HIV infections occur in these groups, according to the Joint United Nations Programme on HIV/AIDS.

Guideline Recommendations

One of the major recommendations in the guidelines is that an HIV-prevention method called pre-exposure prophylaxis, or PrEP, be part of prevention efforts for men who have sex with men. PrEP involves taking a daily pill containing two medicines, and it can help protect an uninfected person against HIV -- although it's not 100% effective.

"There is strong evidence for this recommendation," said guideline chair Chris Beyrer, MD. He's the director of the Johns Hopkins Center for Public Health and Human Rights in Baltimore, and president-elect of the International AIDS Society.

Beyrer stressed, though, that PrEP treatment is not recommended for all men who have sex with men -- only those who want the treatment and who are at risk for HIV. He explained that PrEP must be used with other prevention methods, such as condoms, condom-appropriate lubricant, and education.

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