2022 WHO Consolidated Guidelines on Person-centred HIV Strategic Information

WHO
2022-07-29

ISBN: 978-92-4-005531-5

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Analysis of evidentiary value

The World Health Orga­ni­za­tion (WHO) is the UN’s direct­ing and coor­di­nat­ing author­ity for health. WHO’s Sec­re­tariat serves the organ­i­sa­tion’s 194 Mem­ber States by imple­ment­ing the res­o­lu­tions and deci­sions of the World Health Assem­bly through its global and regional head­quar­ters as well as its 150 coun­try offices. The WHO Sec­re­tariat derives nor­ma­tive author­ity from its exper­tise and polit­i­cal neu­tral­ity. It is a widely respected pub­lic health author­ity in the UN sys­tem and beyond. Its guide­lines and tech­ni­cal reports are author­i­ta­tive sources of evi­dence.

Used as precedent

key and vulnerable populations

• “While the over­all inci­dence of new infec­tions has been declin­ing since the peak in 1997, the pro­por­tion of these new infec­tions that occur among peo­ple from key pop­u­la­tions (men who have sex with men, sex work­ers, peo­ple who inject drugs, trans and gen­der diverse peo­ple, and peo­ple in pris­ons and other closed set­tings) con­tin­ues to increase. In 2021 peo­ple from key pop­u­la­tions and their sex­ual part­ners accounted for 70% of new infec­tions glob­ally and 94% of new infec­tions out­side of sub-Saha­ran Africa. In sub-Saha­ran Africa as well, key pop­u­la­tions and their sex­ual part­ners make up an increas­ing pro­por­tion of new infec­tions, from 25% in 2016 to 51% in 2021.” (p. 21)

gender equality

• “While the over­all HIV bur­den is higher in girls and women, men are less likely to get tested for HIV and, if infected, less likely to be on treat­ment and less likely to be virally sup­pressed. A grow­ing body of evi­dence shows that men have less access than women to HIV pre­ven­tion, test­ing and ART.” (p. 21)

universal health coverage

• “World­wide, an esti­mated 5% of all cer­vi­cal can­cer cases are attrib­ut­able to HIV, and women liv­ing with HIV have a six-fold higher risk of cer­vi­cal can­cer than women who are not infected with HIV. An esti­mated 85% of women with both cer­vi­cal can­cer and HIV live in sub-Saha­ran Africa, under­scor­ing the major con­tri­bu­tion of HIV to the cer­vi­cal can­cer bur­den in the region, con­tribut­ing to the geo­graphic dis­par­i­ties seen in cer­vi­cal can­cer bur­den.” (p. 163)

• “Sub­stan­tial evi­dence indi­cates that STIs increase HIV trans­mis­si­bil­ity and the risk of acquir­ing HIV by as much as 2–3 times in some pop­u­la­tions. The increased trans­mis­si­bil­ity may result from STI sores or inflam­ma­tion allow­ing infec­tion that might oth­er­wise have been stopped by intact skin and from increased HIV shed­ding among peo­ple with HIV who have ure­thri­tis or a gen­i­tal ulcer or are infected with N. gon­or­rhoeae. Gen­i­tal her­pes (HSV-2) almost triples the risk of acquir­ing HIV for both men and women. Also, HIV increases the infec­tious­ness and sever­ity of STIs, and a recent study has doc­u­mented that HIV and syphilis co-infec­tion can have an adverse impact on immune recov­ery and anti­retro­vi­ral effec­tive­ness.” (p. 166)

sex characteristics

• “WHO rec­om­mends start­ing cer­vi­cal can­cer screen­ing at age 25 years for women liv­ing with HIV, but some women may be screened ear­lier and it is impor­tant to cap­ture this. Gen­der cat­e­gories should include all gen­der diverse peo­ple with a female repro­duc­tive sys­tem such as trans­gen­der men and gen­der diverse indi­vid­u­als who have a cervix, while main­tain­ing pol­icy-pro­tected con­fi­den­tial­ity and pri­vacy for these data to pre­vent their mis­use.” (p. 178)

intersectionality

• “Epi­demi­o­logic research con­ducted through national sur­veys, clin­i­cal tri­als and cohort stud­ies has shown that HIV inci­dence varies con­sid­er­ably between and within dif­fer­ent geo­graphic areas and pop­u­la­tion groups in a coun­try.” (p. 189)

• “In mature epi­demics HIV preva­lence tends to be lower among preg­nant women above age 20 than among non-preg­nant women, with the rel­a­tive dif­fer­ence grow­ing with increas­ing age and older age of sex­ual debut. In con­trast, preg­nant ado­les­cents, ages 15-19 years, tend to have higher HIV preva­lence than non-preg­nant ado­les­cents.” (p. 205)

• “A recent analy­sis of pro­gramme-dri­ven sur­vey data col­lected among ado­les­cent girls (ages 16 to 19 years) who sell sex in Zim­babwe reported a steep rise in HIV preva­lence, from 2.1% among those age 16 years to 26.9% among those age 19.” (p. 208)