Key Populations

HIV disproportionately affects key populations, which include:
  • Sex workers
  • People who inject drugs
  • Transgender people
  • Men who have sex with men
UNAIDS estimates that between 40 and 50% of all new HIV infections among adults worldwide occur among these key populations and their sex partners. As some of the most marginalized groups in the world, key populations experience heightened vulnerability to HIV and human rights abuses, as well as greater barriers to accessing care and support, including:
  • Stigma and discrimination, including provider bias against FP use for unmarried women or female sex workers
  • Laws criminalizing their behavior
  • Human rights abuses and violence
  • Lack of provider knowledge and skills related to the reproductive health and FP needs of key populations, including how to address their fertility intentions
  • Lack of services related to gender-based violence within FP settings
  • Lack of proper counseling on dual method use, condoms, and emergency contraception
  • Lack of community and social support.
Key populations who do access the healthcare system are often met with refusals of service, abusive treatment, or the provision of inadequate or inappropriate care. Not surprisingly, female members of key populations also experience disproportionately high rates of unintended pregnancy and abortion. Contraception is a service that is often overlooked for key populations, but is an essential component of a comprehensive package of care for them. Even less attention has been given to safer pregnancy planning for key populations. HIV programs serving key populations provide an important opportunity to address their broader reproductive health needs. The delivery of integrated FP/HIV services tailored to key populations may include:
  • Provision of FP services within “key population-friendly” HIV care and treatment settings, staffed by unbiased providers who are knowledgeable and skilled in addressing the needs of key populations 
  • Provision of counseling and referral to FP programs within drop-in centers or via peer educators, as well as referral for PMTCT/ANC for pregnant clients 
  • Supporting key population peer educators to accompany clients to FP or PMTCT/ANC services
  • Close monitoring of referrals between sites serving key populations and FP service delivery sites to ensure uptake of services
  • The availability of gender-based violence screening and referrals for support within the integrated site
This section of the Family Planning and HIV Services Integration Toolkit houses resources focused on key populations, including reports, briefs, training tools, and videos. A series of success stories also offers concrete examples of interventions making an impact among key populations.