Key Populations

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Too often, the populations most vulnerable to disease are the same populations that don’t have access to health care. Factors such as stigma, discrimination and criminalization drive these populations underground and away from the health services they need.

To solve this problem, we have to provide services for key populations as well as invest in programs that address the barriers that keep people away from services. The best way to do this is to involve key populations in the design, delivery and monitoring of those health services.

Who are key populations?

They are groups that experience both increased impact from one of the diseases and decreased access to services. It also includes groups that are criminalized or otherwise marginalized.

For example, in the context of HIV, key populations include:

  • Men who have sex with men
  • Transgender people
  • Sex workers
  • People who inject drugs
  • People living with HIV

A more comprehensive definition of “key populations” is available for download below.

  • Key Populations: A Definition
    download in English

The Global Fund also recognizes vulnerable populations - those who have increased vulnerabilities in a particular context, i.e. adolescent/women and girls, miners and people with disabilities.

“To defeat the modern day plague, we must overcome discrimination in laws, in practice and in our hearts. We must grasp another historic opportunity: to become better people and societies built on the firm foundation of an inclusive human family – our natural family.”
Mark Dybul & Hon. Michael Kirby AC CMG

Engagement of key populations

If we are to have an impact on the three diseases, networks and organizations of key populations need to be involved. Key populations should be engaged in the process at every stage of the funding cycle. This includes:

  • Governance
  • Design
  • Implementation
  • Monitoring

Governance: Engagement starts with governance. At the global level, there is a seat on our Board representing communities living with the diseases, and this includes key populations.

In each country, we require the Country Coordinating Mechanism to include people who represent those affected by the three diseases. This includes representatives of people living with HIV, people affected by TB, people living with malaria. This requirement also applies to key populations in the context of the three diseases (see comprehensive definition, available below).

“Most injecting drug users don’t go to government clinics because they find it daunting to deal with all the paperwork, especially those who came out from prison. They feel stigmatized and that staff is arrogant and looks down on them because of their tattoos and their drug use.”
Prasert Liangrak, Raks ThaiCommunity health worker, Thailand

Design: The design and development of programs/services should involve those representing key populations, including in:

  • The country dialogue
  • The development of the concept note
  • The grant-making process

Networks or organizations of key populations have a great deal of expertise when it comes to knowing the needs of their communities and especially when it comes to making sure that services deliver impact.

Implementation: Services for key populations are frequently best delivered by those same key populations. Peer outreach for young people who inject drugs, for example, or HIV awareness campaigns targeting sex workers that are delivered by sex workers. We work with implementers of programs to be sure that they are tailored to the needs of different key populations.

Monitoring: Beyond delivering services these networks and organizations are also a valuable resource to monitor the work being done by programs. Not only do they verify that services are being delivered as planned, but that those services reach the right people and respect their rights.

Key Populations Action Plan

To ensure that our resources are put to work to meet the needs of key populations, the Global Fund launched a Key Populations Action Plan in July 2014.

This action plan builds upon the 2009 Sexual Orientation and Gender Identity strategy and outlines:

  • how we will support countries to reach key populations with services
  • how we will invest more strategically
  • how we will drive improved data collection
  • how we will support meaningful engagement
  • how we will support advocacy by and for key populations

A more comprehensive guide to the Key Populations Action Plan is available for download below.

“The Global Fund should play a role in helping civil society build a constructive relationship with governments in order to change the systems in our countries, because in many cases the laws and policies are in the way of the HIV response and HIV programs.”
Sergey Votyagov, Eurasian Harm Reduction Network, at the Global Fund Partnership Forum 2015

Supporting community advocacy

The Asia Pacific Network of People Living with HIV (APN+) received a US$2.8 million grant in 2011 to fund a program whose goal is to improve the quality of life of people living with HIV in Asia and the Pacific by strengthening community responses to AIDS.

Thanks to this grant, community organizations led by people living with HIV in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Viet Nam have been able to advocate for their needs with health officials, leading to concrete policy changes that are evidence-based. The organization also created a regional database to document, monitor and advocate on issues related to treatment access for people living with HIV.

Investing in key populations

The Global Fund recognizes that there may be gaps in knowledge, data or expertise at the country level that might make it more difficult for key populations to engage. So we created a special initiative to make sure that networks and organizations of key populations can receive technical assistance to bridge those gaps.

This technical assistance is provided to civil society organizations to help them participate in the country dialogue, concept note and grant-making stages of the Global Fund’s funding process.

Technical assistance is also available to support civil society networks to develop their long-term capacity.

Through a partnership with the Robert Carr Civil Society Networks Fund, the Community, Rights, Gender Special Initiative has funded eight global and regional key population networks to mobilize their respective constituencies to engage in Global Fund processes at the country level. The grantees include networks of sex workers, transgender people, people who use drugs, men who have sex with men, young key populations, and people living with HIV, including women living with HIV. As of January 2016, around US$5 million had been committed over two years to fund activities in over 40 countries and every region of the Global Fund portfolio.

In addition, the Global Fund launched a Key Affected Populations Country Coordinating Mechanism Pilot Project in June 2013. The pilot provided funds to Country Coordinating Mechanisms in ten countries to support the greater engagement of key populations and people living with the diseases in funding processes. ICASO conducted an independent evaluation of the pilot, which can be found under "Related Resources"

“Societal gender norms strongly affect the ability of women, men, transgender persons and young people to access HIV information and services, and affect their attitudes and sexual behavior”
Setia Perdana - Fokus Muda - Indonesian Young Key Affected Forum, Indonesia - W4GF

Tools for key population programming

The Global Fund is investing US$6 million over 2014-2016 to fund new approaches to estimating the size of key populations and to programmatic mapping in 16 countries. These size estimations must take into account human rights, ethics and meaningful community engagement. Improved size estimates will lead to improved program design.

Work is also underway on an analysis of the amount as well as a qualitative analysis of factors influencing increased or decreased of resources invested in key population programming across the Global Fund grant portfolio.

Published 14 November 2016