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Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations – 2016 Update. Geneva: World Health Organization; 2016.

Cover of Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations – 2016 Update

Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations – 2016 Update.

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DEFINITIONS OF KEY TERMS

Definitions used in this guideline are aligned with current consensus definitions used in the Global Health Sector Strategy on HIV/AIDS 2011–2015 (1) and by the United Nations, as described in the Joint United Nations Programme on HIV/AIDS (UNAIDS) “Guidance note on HIV and sex work”(2) and other relevant World Health Organization (WHO) and other United Nations documents.

Key populations are defined groups who, due to specific higher-risk behaviours, are at increased risk of HIV irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviours that increase their vulnerability to HIV. These guidelines focus on five key populations: 1) men who have sex with men, 2) people who inject drugs, 3) people in prisons and other closed settings, 4) sex workers and 5) transgender people. People in prisons and other closed settings are included in these guidelines also because of the often high levels of incarceration of the other groups and the increased risk behaviours and lack of HIV services in these settings. The key populations are important to the dynamics of HIV transmission. They also are essential partners in an effective response to the epidemic (1).

Vulnerable populations are groups of people who are particularly vulnerable to HIV infection in certain situations or contexts, such as adolescents (particularly adolescent girls in sub-Saharan Africa), orphans, street children, people with disabilities and migrant and mobile workers. These populations are not affected by HIV uniformly across all countries and epidemics. These guidelines do not specifically address vulnerable populations, but much of the guidance can apply to them.

Men who have sex with men refers to all men who engage in sexual and/or romantic relations with other men. The words “men” and “sex” are interpreted differently in diverse cultures and societies and by the individuals involved. Therefore, the term encompasses the large variety of settings and contexts in which male-to-male sex takes place, regardless of multiple motivations for engaging in sex, self-determined sexual and gender identities, and various identifications with any particular community or social group.

People who inject drugs refers to people who inject psychotropic (or psychoactive) substances for non-medical purposes. These drugs include, but are not limited to, opioids, amphetamine-type stimulants, cocaine, hypno-sedatives and hallucinogens. Injection may be through intravenous, intramuscular, subcutaneous or other injectable routes. People who self-inject medicines for medical purposes – referred to as “therapeutic injection” – are not included in this definition. The definition also does not include individuals who self-inject non-psychotropic substances, such as steroids or other hormones, for body shaping or improving athletic performance. While these guidelines focus on people who inject drugs because of their specific risk of HIV transmission due to the sharing of blood-contaminated injection equipment, much of this guidance is relevant also for people who inject other substances.

People in prisons and other closed settings: There are many different terms used to denote places of detention, which hold people who are awaiting trial, who have been convicted or who are subject to other conditions of security. Similarly, different terms are used for those who are detained. In this guidance document, the term “prisons and other closed settings” refers to all places of detention within a country, and the terms “prisoners” and “detainees” refer to all those detained in criminal justice and prison facilities, including adult and juvenile males and females, during the investigation of a crime, while awaiting trial, after conviction, before sentencing and after sentencing. This term does not formally include people detained for reasons relating to immigration or refugee status, those detained without charge, and those sentenced to compulsory treatment and to rehabilitation centres. Nonetheless, most of the considerations in these guidelines apply to these people as well (3).

People who use drugs include people who use psychotropic substances through any route of administration, including injection, oral, inhalation, transmucosal (sublingual, rectal, intranasal) or transdermal. Often this definition does not include the use of such widely used substances as alcoholic and caffeine-containing beverages and foods.

Sex workers include female, male and transgender adults (18 years of age and above) who receive money or goods in exchange for sexual services, either regularly or occasionally. Sex work is consensual sex between adults, can take many forms, and varies between and within countries and communities. Sex work also varies in the degree to which it is more or less “formal”, or organized (4).

As defined in the Convention on the Rights of the Child (CRC), children and adolescents under the age of 18 who exchange sex for money, goods or favours are “sexually exploited” and not defined as sex workers (5).

Many individuals will relate to more than one key population. For example, some men who have sex with men and some transgender people may also engage in sex work and/or inject drugs.

Transgender is an umbrella term for people whose gender identity and expression does not conform to the norms and expectations traditionally associated with the sex assigned to them at birth; it includes people who are transsexual, transgender or otherwise gender non-conforming (6, 7). Transgender people may self-identify as transgender, female, male, transwoman or transman, trans-sexual or, in specific cultures, as hijra (India), kathoey (Thailand), waria (Indonesia) or one of many other transgender identities. They may express their genders in a variety of masculine, feminine and/or androgynous ways. The high vulnerability and specific health needs of transgender people necessitates a distinct and independent status in the global HIV response.

Sexual risk differs among different subgroups within the transgender community. For example, sexual risk may be higher among transgender women (male to female) or transgender men (female to male) who have receptive anal intercourse with men than among transgender men or transgender women who have sex only with women. The prevalence of HIV among transgender women in many countries is as high as or higher than among men who have sex with men. Owing to these differing sexual risk profiles, the focus of this consolidated guideline is on transgender women or transgender men who have sex with men rather than on transgender women and transgender men who have sex only with women (8).

Children: According to Article 1 of the Convention on the Rights of the Child, “A child means every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier”(5).

Adolescents: Individuals between the ages of 10 and 19 years old are generally considered adolescents. Adolescents are not a homogenous group; physical and emotional maturation comes with age, but its progress varies among individuals of the same age. Also, different social and cultural factors can affect their health, their ability to make important personal decisions and their ability to access services (9).

This document primarily uses the term “adolescents”. Other terms covering overlapping age groups include:

Youth: This term refers to individuals between the ages of 15 and 24 (10).

Young people: This term refers to those between the ages of 10 and 24 (10).

Copyright © World Health Organization 2016.

All rights reserved. Publications of the World Health Organization are available on the WHO website (http://www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: tni.ohw@sredrokoob).

Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/copyright_form/index.html).

Bookshelf ID: NBK379697

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