Addressing Key Population vital in fight against HIV/Aids
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TANZANIA as a country has made great progress in addressing health challenges facing its citizens and one of the key areas is in the fight against HIV Aids.

The fourth phase government under former President Jakaya Kikwete went to great lengths in motivating people to go for voluntary testing, and the saying ‘Tanzania bila ukimwi inawezekana’ (Tanzania without HIV/Aids is possible) echoed in all corners of the country.

The media went on the warpath, reverberating on the HIV/ Aids war cry, and in every corner of the country, billboards were pulled up, screaming to all who have ears to heed the warning of shunning away from the scourge.

These efforts, by far and large, are very commendable, and kudos must go to the government for reminding its citizen that they have a part to play in ending the dreaded disease, but this fight is far from over if one group is not brought aboard, Key and Vulnerable Populations.

It is in this context that the government has endorsed several global commitments and the respective plans of actions, including SDGs, the 2016 UNGA Political Declaration on HIV and AIDS; among others.

The commitments made by Tanzania aim to improve the quality of life and achieve elimination of new HIV infections in the general population, especially where new infections are concentrated. In line with this, Tanzania has developed National Guidelines which will guide and standardize the implementation of a comprehensive package of HIV and Health Interventions for the Key and Vulnerable Populations who are at high risk for HIV.

When we talk about Key Population (KP), we define groups who, due to specific higher-risk behaviors, are at increased risk of HIV irrespective of the epidemic type or local context.

Also, they often have legal and social issues related to their behaviors that increase their vulnerability to HIV. World Health Organization guidelines focus on five key populations, men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people. The key populations are important to the dynamics of HIV transmission. They also are essential partners in an effective response to the epidemic.

The HIV epidemic in Tanzania has existed for three decades and has claimed many lives. Over the years, collective efforts to control the epidemic have seen HIV prevalence decline progressively among adults aged 15-49 from 7 percent in 2003 to 5.1 percent in 2015.

However, several vulnerable groups such as street living and working children, adolescent girls and young women, long distance truck drivers, people in mining and construction industries, fishermen and fishing villages communities, displaced people, people with disability and plantation workers remain at high risk of HIV infection. Key populations who are at higher risk of HIV infection include people who use and inject drugs, men who have sex with men, transgender people, sex workers and prisoners.

According to UNAIDS Spectrum (2015), there is an increased number of new infections among younger populations. 43 percent of all new infections in Tanzania are among those aged 24 years of age and younger.

Adolescent girls and young women face higher risks of HIV infection. 70 percent of adolescent newly infected with HIV in the country are girls. The HIV prevalence increases 2.2 fold among girls during their transition to adulthood (0.8 percent for 15-19 year olds to 2 percent for 20-24 year olds).

To ensure an effective and sustainable response to HIV, there is a need to reach out to KVPs with a comprehensive package of prevention, treatment, care, support interventions and other public health services.

The interventions in the national guideline emerge and expand upon both from earlier and current key government policy documents to address HIV and AIDS, and also include evidencebased practices from WHO and other United Nations agencies.

Global research findings suggest that, HIV and Aids affect disproportionately the KPs, particularly people who inject drugs (PWID), men who have sex with men (MSM), transgender, sex workers and prisoners.

When compared to the general population, global data shows that, on an average PWID are 22 times more likely to be HIV positive, transgender 49 times, sex workers 14 times, MSM 13 times and prisoners 6-50 times, depending on specific contexts. Tanzania accounts for 4.5 percent of the global HIV burden, ranking seventh in the world in terms of the total number of reported deaths.

Despite the small number of studies done in Tanzania Mainland, according to the PEPFAR Tanzania Country Operational Plan 2016, the estimated number of VPs include adolescents girls and young women (80,142), fisher community (5,400), people in uniform (61,600) people in mining industry (225,000), prisoners and (8,700) truckers (3,400).

Further evidence indicates HIV prevalence of 36 percent among PWIDS, 26 percent among female sex workers 25 percent among MSM and 6.7 percent from the prisoners. HIV prevalence among transgender people is not known. KVPs are important to the dynamics of HIV transmission in a given setting, and are essential partners in the national response to the epidemic.

There is evidence of overlapping sexual network between KVP and general population, indicating that HIV among key and vulnerable populations is not isolated, and if not addressed accordingly risks the national responses.

To ensure an overall effective and sustainable response to HIV, there is a need for special interventions to reach out to KVPs with comprehensive package of prevention, treatment, care and support interventions and services.

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