National AIDS and STI Control Programme (NASCOP), Ministry of Health, Nairobi, Kenya.
Institute of Global Public Health, University of Manitoba, Winnipeg, MB, Canada.
J Int AIDS Soc. 2021 Jul;24 Suppl 3(Suppl 3):e25729. doi: 10.1002/jia2.25729.
Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya's challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade.
The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non-regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP-led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio-behavioural survey data; inadequate scale-up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma.
To reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale-up quality programmes for KP who are underserved in the HIV response.
关键人群（KP）仍然在全球范围内占据着较高的 HIV 发病率。然而，国家 HIV 预防应对措施仍然优先考虑 KP，导致他们无法充分获得 HIV 项目。本评论旨在分享肯尼亚在实现 2020 年全球 HIV 目标和过去十年中扩大 KP 项目方面所面临的挑战和取得的成功。
在过去的十年中，肯尼亚的 KP 项目已经得到了扩大，将女性性工作者（FSW）、男男性行为者（MSM）、注射毒品者（PWID）、跨性别者和监狱中的人作为国家 HIV 应对措施中的优先人群。根据 FSW 的官方规模估计，KP 的覆盖率为 73%，MSM 为 82%，通过针具交换项目（NSP）的 PWID 为 71%，通过阿片类药物替代疗法（OST）的 PWID 为 26%，跨性别者为 5%。KP 的服务结果在预防方面相对较强，FSW 的最后一次性交易中避孕套使用率高（92%），PWID 中使用无菌设备的比例高（88%），而 MSM 中最后一次性行为与非固定伴侣使用避孕套的比例仍然较低（78%）。该 KP 方案在所有亚人群中都没有达到护理连续体目标，发现的病例很少。由卫生部领导的国家 KP 方案通过以下方式扩大了方案：（a）与 KP 主导的和有能力的组织、研究人员和捐助者建立战略伙伴关系；（b）制定政策指导和方案标准；（c）不断进行宣传和倡导以争取支持；（d）开发国家报告系统等。然而，该方案仍在努力应对不确定的规模估计、缺乏最新的生物行为调查数据、跨性别者和监狱环境中干预措施的扩大不足、未能接触到青少年和青年 KP 以及有效地解决暴力和耻辱等结构性障碍等问题。
要实现雄心勃勃的全球 HIV 目标，关键是为 KP 提供充分的、高质量的 HIV 项目。尽管 KP 方案已经扩大，但肯尼亚尚未实现 2020 年全球 HIV 目标，需要进一步努力扩大在 HIV 应对措施中服务不足的 KP 的优质方案。
