The Shifting Global Health Landscape: Implications for HIV/AIDS and Vulnerable Populations

This issue brief from amfAR, The Foundation for AIDS Research, focuses on the challenge of delivering effective, high-quality, non-discriminatory HIV and AIDS services to vulnerable populations, with specific attention to the needs of men who have sex with men (MSM), injecting drug users (IDUs), and sex workers.

In light of the "enormous barriers to effective service provision for vulnerable populations through mainstream service systems" that are described in the document - for instance, "stigmatizing attitudes among health workers [that] deter many individuals from seeking the health services they need" and "diminish the quality of services for those who access them" - amfAR suggests several strategies found to be effective in reaching vulnerable populations. One example is that of building social capital. The approach of social bonding within key populations involves building on existing social networks, and incorporating advocacy for human rights and service access, and involving peer-led efforts to strengthen social solidarity in order to reduce risk to the community. Examples of networks of sex workers in different parts of the world are provided, such as the Sonagachi Project in Calcutta, India, which used multi-faceted, multi-level interventions grounded in a community empowerment approach to "achieve remarkable health outcomes for local sex worker networks".

Based on this analysis, amfAR offers recommendations to guide action, which include:

• Increase investments and support for service channels specifically designed for vulnerable populations;
• Build capacity of health systems to address needs of vulnerable populations: "Through a combination of training, mandates, and regulations, health systems should begin the process of de-mystifying service provision for marginalized populations by educating providers about their specific health and sexual health needs, alleviating health workers' prejudices, dispelling myths and misconceptions, and putting in place rules that require that all patients receive fair and equal treatment...";
• Ensure "a robust mix of services that include non-discriminatory, culturally appropriate services operated by the government, as well as tailored services conceptualized and delivered by communities themselves. This approach will require extensive capacity-building efforts..."; and
• Engage in advocacy: "Laws should be revised to prohibit discrimination on the basis of membership in a marginalized group....Public education campaigns should be initiated to change social norms and attitudes regarding MSM, drug users, and sex workers. These should be supported by school-based programs that work to produce future generations that are more tolerant and accepting of difference."