Many years of awareness of universal access, with basic populace goals, have actually tended to divert attention far from intercourse employees, males who possess intercourse with men, transgender people, and folks whom utilize medications. 26 unfortuitously, this attention, and associated financing for programs, can be narrowly associated with performance in HIV screening and connecting HIV-positives to therapy.
Yet, cascade targets, and also the largely population that is general connected to them, don’t automatically lead to effective key populace techniques. In a few situations driven mainly by HIV therapy cascade metrics, strong population that is key are in reality penalized whenever their effective avoidance efforts lead to low “yield” of brand new HIV-positives who are able to then be started on ART. 27 even even Worse, narrow service-oriented approaches and goals could have unintended results on programs and key populace communities, weakening prevention and undermining community involvement and resilience.
In comparison, communities of sex workers across Asia discovered to interrupt STI/HIV transmission directly while attaining exemplary system performance across cascades. Building on very very early work of Durbar Mahila Samanwaya Committee into the Sonagachi part of Kolkata, intercourse employees in Mysore replicated, innovated, and adapted with their very very own context, to interrupt STI/HIV transmission, make sure treatment that is high and retention, and tackle a selection of health insurance and social dilemmas impacting their community. Classes because of these experiences can notify effective key population programming elsewhere. 9,10,13–16,28