Stigma and discrimination, human rights abuses and challenging legal environments can prevent members of key populations at higher risk—such as men who have sex with men, people who use drugs and sex workers—from realizing the benefits of recent advances in science. UNAIDS and the New York Academy of Sciences therefore held a symposium in New York on 5 May to explore the links between science, community and policy in order to improve access to HIV services for key populations at higher risk.

The participants recognized that key populations have been left behind by the advances made in science over the past few years. The challenge, they said, is to frame the political and structural agenda in such a way that the fruits of scientific discoveries can be shared with the whole of society.

According to the participants, solutions should be based on strong public health arguments and advocate for client-friendly services that improve access to services and not only reduce morbidity and mortality among the direct beneficiaries but also reduce onward transmission. Scientists are taking up the challenge of the special risks that key populations encounter, in terms of both the rapid spread of HIV infection—requiring new HIV prevention technologies—and in terms of comorbidities and the need for integrated HIV services.

Participants

The symposium brought together scientists, policy-makers and HIV service providers, advocates, and activists and community members from around the world.

Common messages discussed

• Community-led approaches offer ways to improve access to integrated services for most key populations.
• Providing access to HIV services to people in the very earliest stages of HIV infection may reduce the long-term consequences of inflammation and immune dysfunction.
• New HIV prevention technologies, such as pre-exposure prophylaxis, which may soon become available as a three-monthly injection, could provide an important addition to the HIV prevention package for men who have sex with men and for women at higher risk of HIV exposure, such as sex workers in high-prevalence countries.
• Coinfections and comorbidities are particularly relevant to many key populations and hence the advances in treatment for hepatitis C and approaches to manage tuberculosis in prisons, or sexual and reproductive health services for sex workers along trucking routes, are major steps forward.