amfAR, The Foundation for AIDS Research

Effective HIV Response Requires Better Use of Key Populations Estimates

It is estimated that 40−50% of new HIV infections worldwide occur among what are referred to as “key populations”—gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender individuals—and their sexual partners.1 Yet it is these very groups, often marginalized and discriminated against, that are frequently left behind in efforts to scale up HIV prevention and treatment.

amfAR’s Christina Chandra, Jack MacAllister, and Jennifer Sherwood pose with the public policy office’s posters and publications at AIDS 2016
HIV policy analysts agree that for the world to achieve the goal of the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic by 2030, efforts must be targeted to reach key populations. But in much of the world, even the most basic data on these populations is lacking. What’s more, the quality and integrity of the data that are available can be questionable. And even when data on key populations exists, it is often not being used to guide policy.

Recognizing the necessity of targeting key populations, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, along with many national governments and donors, have placed a renewed emphasis on putting data at the center of program planning and policy decision making. The amfAR public policy office has been working with PEPFAR, the Global Fund, and the Johns Hopkins University Center for Public Health and Human Rights to study the availability, quality, and use of key populations data in policy decision-making.

As part of this effort, amfAR and Johns Hopkins recently conducted a systematic review of key population size estimates and an assessment of how they are being used to guide HIV responses and resource allocation.2 This review was presented in July at the 2016 International AIDS Conference in Durban, South Africa, along with two amfAR reports on key populations issues.3

“The lessons learned from amfAR’s key populations analyses are applicable around the world, especially in the Asia-Pacific region where our national epidemics are frequently concentrated within these groups.”

“Our study looked at key population size estimates in Africa from 2009 to 2016,” said the review’s author Jack MacAllister, Senior Policy Associate at amfAR. “We found limited evidence that available data are being used effectively to guide the HIV response. While we identified 71 key population size estimates, including 55 that were used to identify a problem, only 11 were used to develop a plan of action or recommendation to address that problem. We also found that stakeholders who represent the key populations were inadequately engaged in planning and conducting the estimates.”

“Population size estimates are vital to establishing effective programs to stem the HIV/AIDS epidemic,” he continued. “However, we can’t let their flaws stand in the way of progress. Instead, we need to build capacity in high-impact areas to ensure effective use of data to guide HIV funding and programmatic responses, and to make evidence-based decisions to address the data gaps.”

“The lessons learned from amfAR’s key populations analyses are applicable around the world, especially in the Asia-Pacific region where our national epidemics are frequently concentrated within these groups,” said Dr. Annette Sohn, director of TREAT Asia. “It is essential that our regional and global size estimates of people living with HIV are reliable and actively utilized to guide resource allocation if we hope to reach those most at risk of HIV.”

To accelerate the scale-up of HIV testing and treatment services for key populations and to improve health outcomes in these groups, amfAR’s public policy office has identified strategic action steps for PEPFAR; the Global Fund, UNAIDS, and national AIDS programs. These recommendations will be published in an upcoming report titled Ending the AIDS Epidemic Among Key Populations: An Action Agenda.


1. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. 2014, World Health Organization: Geneva.

2. S. Baral, C. Lyons, E. Sullivan, S. Kurani, J. Sherwood, G. Millett, J. MacAllister. The uptake of population size estimation studies for key populations in guiding HIV responses across sub-Saharan Africa: a systematic review. Abstract presented at 2016 International AIDS Conference, Durban, South Africa, July 2016.
(Presentation video)
(Presentation slides)

3. Following the Money to Key Populations, National Priorities, and Evidence-Based Budgeting and Is PEPFAR Funding for Key Populations Aligned with the Epidemiologic Burden?