Prior to the start of the 2014 International AIDS conference in Melbourne, the World Health Organisation (WHO) has published their first consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. The report combines all existing guidance relevant to key high-risk groups including men who have sex with men (MSM), people who inject drugs (PWID), people in prisons, sex workers and transgender populations. WHO claims focusing on these key populations will help tackle and control the HIV epidemic, providing both guidelines for adults and adolescents within these key groups.
The report provides new recommendations to existing HIV prevention, treatment and care. One major recommendation is the use of pre-exposure prophylaxis (PrEP) for all MSM as an additional HIV prevention method.
PrEP when taken consistently has been found to reduce the risk of HIV infection by 92 percent. This new recommendation to prioritise PrEP for HIV-negative MSM is a result of the growing HIV epidemic among this group. It has been suggested that encouraging MSM to take PrEP could lead to a 25 percent reduction in new cases across the globe and prevent a one million new HIV infections over the next 10 years. WHO strongly suggests promoting PrEP amongst MSM alongside existing prevention strategies such as routine HIV testing, risk-reduction counselling and provision of condoms.
Despite WHO recommending PrEP alongside other prevention methods, there is concern that promoting PrEP could result in a reduction in the use of condoms, the most promoted HIV prevention method. A reduction in condom use and a reliance on PrEP could lead to complacent attitudes regarding safe sex, potentially leading to more risky behaviour and the spread of other sexually transmitted diseases (STDs).
The focus of PrEP for all MSM is also arguably perpetuating a negative stereotype, marginalising MSM further within the HIV and AIDS. Furthermore, evidence of how effective PrEP will be for preventing HIV among MSM populations is still required and until these results are published, promoting condoms and regular testing is fundamental. It is therefore important that these recommendations are implemented alongside other prevention strategies, ensuring that a reliance on one method does not take precedence.