West African States Make Progress Towards Equitable Access to Health for Key Populations

September 15, 2020

A person in Benue state, Nigeria has blood drawn for an HIV test. Photo: STARS/Kristian Buus.

According to the most recent data, HIV prevalence continues to be significantly higher among men who have sex with men, transgender people, sex workers, people who use drugs and prisoners (or key populations).

As part of efforts to reduce the disproportionate burden of HIV, as well as TB, hepatitis and limited access to sexual and reproductive health and rights (SRHR), among key populations in West Africa, a new Regional Strategy has been developed and is being put into action.

The 2020-2025 Regional Strategy for HIV, Tuberculosis, Hepatitis B&C and Sexual and Reproductive Health and Rights among Key Populations in the Economic Community of West African States was developed by the Economic Community of West African States (ECOWAS) through the West African Health Organization (WAHO), with support from UNAIDS, the World Health Organization (WHO) and the United Nations Development Programme (UNDP).

It aims to guide, harmonize and drive scale-up of regional and national responses for key populations in the ECOWAS region. The Strategy provides Member States with a comprehensive set of accessible, acceptable, affordable and appropriate services for key populations, which if put into action could result in incidence rates stabilizing or even reversing.

In West and Central Africa, 60 percent of new HIV infections occur among key populations. Key populations also face other health problems, besides HIV. TB is the leading cause of death for people living with HIV, and viral hepatitis B and C also disproportionately affect these vulnerable groups, especially people who inject drugs and men who have sex with men. 

The Strategy identifies a number of problems hindering an effective health response, including inadequate funding and scaling up of programming, a lack of ownership of political commitments at national levels, and a lack of homogeneous and standard key population interventions and data generation mechanisms throughout the region.

Furthermore, as Professor Stanley Okolo, Director General of WAHO notes in the Strategy’s Preface: “The criminalization of the sexual practices of key population groups, in addition to pervasive stigma and discrimination against them, hinders their access to HIV programmes in the ECOWAS region.”

"Despite the progress that has been made on interventions targeting key populations, programmes seeking to address their needs remain hard to implement and the populations remain difficult to reach,” said Deena Patel, Programme Manager at UNDP. "We can't afford to let these groups fall further behind – the time to act is now."

The Strategy was developed through an extensive collaborative process, involving stakeholders from key populations communities to government, development partners and civil society, starting in 2018 with a regional consultation organized by UNDP, UNAIDS and ENDA Santé, and attended by representatives of the National AIDS Commissions (NACs) from ECOWAS countries, the Southern African Development Community (SADC) and the Africa Key Populations Expert Group (AKPEG).

Inputs on drafts of the strategy were provided by members of a technical working group comprising WAHO, UNDP, WHO, UNAIDS and other UN agencies including UNFPA, UN Women, UNODC, key populations representatives and NACs from ECOWAS countries. In addition, there was a specific review session of the strategy by the AKPEG during one of their annual meetings in South Africa, and it was presented by the Director General of WAHO at a session at the virtual 2020 International AIDS Conference.

The Regional Strategy was formally adopted by ECOWAS, and is now being put into action across the region, with implementation steered by a set of four ‘Guiding Principles’: respect of human rights, sustained community participation and empowerment, evidence-based and people-centred interventions, and strong political commitment.

The Strategy is available in English, French and Portuguese.