The majority of people living with HIV worldwide belong to a high-risk group (70%). Those affected are:
The WHO's declared goal is to end the health threat posed by HIV and to combat discrimination against those affected by the year 2030. This project depends to a large extent on optimising medical care for the individuals who belong to the above-mentioned groups in particularly high risk. In this context, it is important that structural barriers are reduced and services improved. How this should be implemented can be read in the new WHO guideline on HIV, hepatitis and STDs. The document, which focuses on the needs of the at-risk population, explains aspects of prevention, care, diagnosis and treatment. The most important updates and additions to the guideline were explained by Virginia Macdonald (WHO, Switzerland) at this year's AIDS Congress:
It is now known that a risky lifestyle (e.g. not using condoms, using used hypodermic needles for drug abuse) can hardly be changed by behavioural therapy measures. Accordingly, this prevention method should no longer be mainly used. It is more effective to provide detailed information material and to conduct counselling sessions openly and non-judgmentally, as Macdonald emphasised.
Another WHO recommendation on how to reduce the risk of AIDS, hepatitis and STDs relates to the issue of "chemsex" (definition: sex under the influence of stimulant drugs). The guideline advises a non-critical, person-centred approach in this regard. Information for chemsex practitioners and their partners should cover sexual and mental health, access to sterile needles and opioid replacement therapy.
In addition, two new updates regarding the approach to hepatitis C are added to the guideline: affected people whose hepatitis C infection has healed spontaneously or through treatment should be tested for HCV viraemia every three to six months if they continue to lead a risky lifestyle. This early and relatively frequent testing allows more people with the disease to be filtered out and, in addition, therapy can be initiated promptly. The second recommendation relates to the treatment of hepatitis C in the high-risk group: people with a new HCV infection should be offered drug therapy immediately. It is not recommended to wait until a spontaneous remission occurs.
The guideline emphasises the importance of encouraging the high-risk population to self-manage their health and to promote their self-responsibility. This includes HIV and hepatitis C self-testing. Peer counsellors who are in the same life situation as those seeking advice also play an important role. They can, for example, support patients in starting and continuing therapy.
Furthermore, virtual care services can be useful (e.g. online case management or individual health information) and are advocated by many people affected. However, this should only be a complementary service and should not completely replace personal contacts.
The updated WHO guideline on the care of high-risk groups for HIV, hepatitis and STDs should help to provide adequate support to particularly at-risk persons in all areas of health management. By implementing the recommendations, the quality and duration of life of those affected can be significantly improved globally.
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Macdonald, Virginia, WHO (Schweiz), Vortrag: What's new in the key population guidelines. Sitzung: Launching new WHO guidelines for key populations: Focus for impact, AIDS Kongress 2022, Montreal, 29.07.2022.