title: Maximizing the benefits of antiretroviral therapy for key affected populations.
abstract: BACKGROUND
  Scientific research has demonstrated the clinical benefits of earlier initiation of antiretroviral treatment (ART), and that ART can markedly reduce HIV transmission to sexual partners. Ensuring universal access to ART for those who need it has long been a core principle of the HIV response, and extending the benefits of ART to key populations is critical to increasing the impact of ART and the overall effectiveness of the HIV response. However, this can only be achieved through coordinated efforts to address political, social, legal and economic barriers that key populations face in accessing HIV services.
  
  
  CONCLUSIONS
  Recent analyses show that HIV prevalence levels among key populations are far higher than among the general population, and they experience a range of biological and behavioural factors, and social, legal and economic barriers that increase their vulnerability to HIV and have resulted in alarmingly low ART coverage. World Health Organization 2014 consolidated guidance on HIV among key populations offers the potential for increased access to ART by key populations, following the same principles as for the general adult population. However, it should not be assumed that key populations will achieve greater access to ART unless stigma, discrimination and punitive laws, policies and practices that limit access to ART and other HIV interventions in many countries are addressed.
  
  
  CONCLUSIONS
  Rights-based approaches and investments in critical enablers, such as supportive legal and policy environments, are essential to enable wider access to ART and other HIV interventions for key populations. The primary objective of ART should always be to treat the person living with HIV; prevention is an important, additional benefit. ART should be provided only with informed consent. The preventive benefits of treatment must not be used as a pretext for failure to provide other necessary HIV programming for key populations, including comprehensive harm reduction and other prevention interventions tailored to meet the needs of key populations. An end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the HIV epidemics among key populations.
authors.affiliation: Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Grubb
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; sarah.beckham@jhu.edu.
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Beckham
authors.affiliation: UN, Geneva, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Kazatchkine
authors.affiliation: Global Network of Sex Work Projects, Edinburgh, United Kingdom.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Thomas
authors.affiliation: International Network of People Who Use Drugs, London, United Kingdom.
authors.forename: Eliot R
authors.initials: ER
authors.lastname: Albers
authors.affiliation: Global Action for Trans* Equality, Buenos Aires, Argentina.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cabral
authors.affiliation: Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.
authors.forename: Joep
authors.initials: J
authors.lastname: Lange
authors.affiliation: Department of Therapeutics, HIV, Hepatitis and Global Health, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vella
authors.affiliation: International AIDS Society, Geneva, Switzerland.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kurian
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D014943:Global Health; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D013997:Time Factors; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV/AIDS; human rights; treatment