Djomand Gaston, Quaye Silas, Sullivan Patrick S
aDivision of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA bDivision of Global HIV/AIDS, Center for Global Health, Center for Disease Control and Prevention, Accra, Ghana cDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Curr Opin HIV AIDS. 2014 Sep;9(5):506-13. doi: 10.1097/COH.0000000000000090.
Globally, HIV infection remains a significant issue for key populations such as men who have sex with men (MSM) and female sex workers. A review of recent articles was conducted for west African countries to assess the burden of disease among female sex workers and MSM, access to services and identify barriers to implementation of services for key populations.
In west Africa, key populations engage in high-risk practices for the acquisition of HIV and other sexually transmitted infections. Available HIV prevalence data fluctuate across and within countries for both MSM and female sex workers and may be five to ten times as high as that of the general population. HIV prevalence varied from 15.9% in The Gambia to 68% in Benin among female sex workers, whereas it ranged from 9.8% in The Gambia to 34.9% in Nigeria for MSM. Yet, important data gaps exist, including key populations size estimations in several countries as well as HIV prevalence, incidence and other biomarkers of HIV risk. Because of sociocultural, legal, political and economic challenges, exacerbated by a poor health system infrastructure, the HIV response is not strategically directed toward programs for key populations in countries with concentrated epidemics. Noteworthy is the low coverage of prevention care and treatment interventions offered to key populations.
Sufficient planning and political will with legal and structural frameworks that reconcile public health and human rights are needed to prioritize HIV prevention, care and treatment programming for key populations programs in west Africa.
在全球范围内，艾滋病毒感染对于男男性行为者（MSM）和女性性工作者等重点人群而言仍是一个重大问题。对西非国家近期的文章进行了综述，以评估女性性工作者和男男性行为者中的疾病负担、服务可及性，并确定针对重点人群的服务实施障碍。
在西非，重点人群从事着感染艾滋病毒和其他性传播感染的高风险行为。男男性行为者和女性性工作者的现有艾滋病毒流行率数据在不同国家之间以及国家内部存在波动，可能比普通人群高五到十倍。女性性工作者的艾滋病毒流行率从冈比亚的15.9%到贝宁的68%不等，而男男性行为者的艾滋病毒流行率在冈比亚为9.8%，在尼日利亚为34.9%。然而，仍存在重要的数据缺口，包括一些国家重点人群规模的估计以及艾滋病毒流行率、发病率和其他艾滋病毒风险生物标志物。由于社会文化、法律、政治和经济挑战，再加上卫生系统基础设施薄弱，在存在集中流行疫情的国家，艾滋病毒应对措施并未战略性地针对重点人群项目。值得注意的是，为重点人群提供的预防、护理和治疗干预措施覆盖率较低。
需要有充分的规划以及政治意愿，并建立协调公共卫生和人权的法律及结构框架，以便将西非重点人群项目的艾滋病毒预防、护理和治疗规划列为优先事项。
