In all countries where there is an HIV epidemic, certain subgroups of the population are at greater risk of HIV than others. These “key” populations include female sex workers (FSWs), men who have sex with men (MSM), transgender people, and people who inject drugs.
While biological and behavioral factors contribute to their vulnerability to HIV, key populations around the world also face stigma, discrimination, and the threat of criminal prosecution, which pose serious barriers to their ability to access high-quality health care and other essential services. To have a sustained impact, any national HIV program must therefore ensure that interventions reach key populations and that services are available, accessible, acceptable, and affordable.
Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) is a five-year project to strengthen HIV prevention, diagnosis, treatment, and care among key populations. Its goal is to reduce HIV transmission among key populations and extend life for those who are HIV positive. It aims to accelerate the ability of partner governments, civil society organizations, and private sector health care service providers to plan, deliver, and optimize a package of comprehensive services, at scale, for HIV prevention, care, and treatment. This “LINKAGES cascade” of services is aligned with the UNAIDS 90–90–90 targets — that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of people diagnosed with HIV will receive sustained antiretroviral therapy (ART), and 90 percent of people receiving ART will have viral suppression (meaning that HIV is at undetectable levels and there is effectively no risk of transmitting the virus to others).
The LINKAGES project began implementation in 2014, and by 2017 was partnering with 29 countries in Africa, Asia, and the Caribbean. In addition to promoting routine HIV testing and counseling among members of key populations, actively enrolling those living with HIV into care, and carrying out interventions that enable them to remain in care, LINKAGES also: (1) helps countries to adopt and scale up evidence-based approaches to service provision; (2) helps key population members mobilize and advocate for changes in discriminatory laws and the conduct of police, health care workers, and policymakers; and (3) works with governments to make programs sustainable for the long term.
LINKAGES has now established a global program acceleration initiative that uses existing partnerships to accelerate and strengthen the delivery of the comprehensive package of services at scale. This initiative provides phased technical assistance, building on the principles of community participation and real-time use of data, to inform programs in the field.
This document: (1) outlines the acceleration initiative; (2) describes the process and the progress made under it using examples from four countries: Côte d’Ivoire, Democratic Republic of the Congo (DRC), Malawi, and South Sudan; and (3) discusses some of the lessons learned. This information may be of interest to those designing and implementing programs for HIV or other diseases, including public health officials and program managers, civil society organizations, advocates, funding agencies, and policymakers.