In a new report, the World Health Organization (WHO) recommends men who have sex with men take antiretroviral medicines to prevent HIV infection, a strategy referred to as pre-exposure prophylaxis, alongside the use of condoms. This first time recommendation comes with WHO urging governments to come up with new prevention options as rates of HIV infection among men who have sex with men remain high worldwide. More generally, the WHO report focuses on reducing new HIV infections among five key populations who are least likely to have access to healthcare services and so threaten global progress on the HIV response. The neglected groups are men who have sex with men, people in prison, people who inject drugs, sex workers, and transgender people. Many countries leave these populations out of their national HIV plans, WHO stated, while discriminatory laws and social policies also create barriers to access.

Studies indicate that women sex workers are 14 times more likely to have HIV than other women, men who have sex with men are 19 times more likely to have HIV than the general population, while transgender women and people who inject drugs may be almost 50 times more likely to have HIV than the general population. “None of these people live in isolation,” says Dr Gottfried Hirnschall, Director of the HIV Department at WHO. “Sex workers and their clients have husbands, wives and partners.”

Along with its new recommendations, WHO also published its most recent statistics. At year-end 2013, around 13 million people were taking antiretroviral therapy (ART), with 11.7 million of these people living in low- and middle-income countries. This has led to a 20 percent drop in HIV-related deaths between 2009 and 2012. Though the number of people dying of AIDS is falling sharply, WHO believes preventive efforts are still lagging with national HIV plans failing to address the needs of the five key population groups. Where policies exist, people still find it difficult to access services while in many countries discrimination may be reinforced by laws that criminalize sexual behaviors, drug use, gender expression, or perceived sexual orientation.

However where laws and policies support access to HIV services for these key populations, illness and death among these groups has declined and new infection rates remain low or have fallen, especially among sex workers and for people who inject drugs. At the International AIDS Conference 2014 in Melbourne, WHO plans to call on governments to re-energize and strengthen their HIV programs. In particular, WHO estimates a 20 to 25 percent reduction in HIV incidence among men who have sex with men could be achieved globally through pre-exposure prophylaxis; according to calculations, this would avert up to one million new infections among this group over 10 years. Pre-exposure prophylaxis or PrEP consists of taking a single pill (usually a combination of two antiretrovirals) every day. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent.