PEPFAR’s Updated Strategy Could Leave Behind Key Populations

Advocates for Youth expresses concern about the new PEPFAR Strategy launched last month by U.S. Secretary of State, Rex Tillerson.

Last month, the President’s Emergency Plan for AIDS Relief (PEPFAR) launched its PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). This strategy included investing in more than 50 countries with three goals in mind: to maintain life-saving treatment; to provide additional services to orphans and vulnerable children; and to accelerate progress toward controlling the HIV pandemic. In PEPFAR’s strategy, Secretary Tillerson noted, “Trump Administration remains deeply committed to the global HIV/AIDS response and to demonstrating clear outcomes and impact for every U.S. dollar spent.” However, without focusing on key populations, the Trump Administration shows it is not deeply committed to ending HIV globally.

Key populations, including sex workers, transgender people, people who inject drugs, men who have sex with men, and incarcerated people, are at higher risk of acquiring HIV and are hardest-hit by the epidemic in many regions. In 2015, for example, key populations accounted for 45 percent of all new infections of HIV and represent 50 percent of people living with HIV who are not on treatment. One reason key populations experience higher rates of HIV prevalence is because of criminal laws and penalties, domestically and globally that keep them from accessing needed health services such as HIV testing and treatment, and even commodities such as male and female condoms..


Criminalization across key populations facilitates stigma and discrimination, making it harder to access healthcare services, such as HIV care and treatment and even commodities like male or female condoms. This stigma also means that young people are more likely to confront negative attitudes and harsh treatment from providers, which exacerbates poor health outcomes. Multiple studies, in fact, have also shown that criminalization deters HIV testing, and does not serve as an effective method of HIV treatment and reduction.

As the largest bilateral donor to global health, and to HIV in particular, the policies, programs, and positions of PEPFAR must not perpetuate this stigma and discrimination.  Reducing new HIV infections among key populations is an essential step towards ending the epidemic as detailed in the HIV Prevention 2020 Road Map.

An increase of programs, financial investment, and commitment from the U.S. government is essential. The failure to prioritize key populations is short sighted, misguided and dangerous.