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Structural barriers to work with sexuality, sexual health including HIV interventions for key population at risk: a paradigm shift is required for sustainablility.

Structural barriers to work with sexuality, sexual health including HIV interventions for key population at risk: a paradigm shift is required for sustainablility.

Individual risk reduction model of HIV interventions operated during 25 years have neither effectively prevented HIV transmission nor improved peoples’ quality of sexual life which is rather buried under the narrow framework of targeted HIV intervention. Program and research data on key-populations at risk (KPAR) during the last 10 years have been reviewed. Content and contextual analysis was performed to critically analyze status of interventions with KPAR and their documented impacts.

Current HIV interventions have not addressed sexual health and well-being, violation of sexual rights, social exclusions, marginalization and poverty based on sexuality, gender dimensions of risk, legal and policy barriers which are the core driving force of vulnerability. Similarly most studies measured behavioral risks but could not explore contextual understandings of risks and safety. Million dollars were spent for purchasing condoms/lubricants but nothing was spent to improve water/sanitation of brothels; millions were spent for operating dropin-centers and STI treatment, but nothing was done to strengthen health systems to be inclusive and sensitive to needs of the vulnerable. Promotion of condoms/lubricants and sterile injecting equipments are yet criticized by the political/religious leaders, whereas significant amount was spent for advocacy and awareness. Consequently, economic, social and sexual well-being, and safety of KPAR remain unchanged. Health systems and implementation research to develop structural interventions, pilot and scale up at national scale is crucial not only for effective control of HIV but also for sustainability through integration to public health systems.

Areas of Interest / Categories: WAS 2013

WAS 2013

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