Reaching sexual partners and children of key populations (KPs) is essential to HIV epidemic control, as HIV prevalence in these populations can be high while awareness of HIV risk and access to services is often limited. In 2022, more than half of all new HIV infections globally occurred among KPs and their sexual partners. Outside of sub-Saharan Africa, KPs and their sexual partners accounted for 80 percent of all new infections. Partners and children of KPs include men who purchase sex; partners of female sex workers; male and female partners of men who have sex with men; partners of people who inject drugs; and children of KP members. The PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project uses tailored approaches to make services more accessible, convenient, and client-friendly for these populations. Some of these tailored approaches include:  

  • Programmatic mapping and size estimation to identify physical and virtual hotspots where KPs and their contacts can be reached. In these hotspots, peer-led outreach and community-based services are used to engage KPs and their partners with HIV and other health services  
  • Strengthening PrEPservices by improving policies, provider training, and messaging so more members of KPs and their partners and children are offered and initiate pre-exposure prophylaxis (PrEP).  
  • Differentiated service delivery for HIV testing and treatment services—which includes PrEP—expands access and demand. 
  • Differentiated testing models include index testing and risk network referrals as well as both in-person and online enhanced peer outreach. These services are offered in both community and facility settings. They are integrated into pediatric and reproductive health units to reach children and young women, and into men’s clinics to reach at-risk men. 
  • Differentiated HIV treatment and viral load testing models include offering these services at community based drop-in centers, one-stop shops, and hybrid clinics. These locations are convenient and offer safe spaces that provide health and social services to KP networks. 
  • Motivational counseling to help identify and respond to reasons for service refusal by clients. This strategy helps peers and providers tailor messages to client needs and preferences. 

Between October 2020 and September 2024, EpiC reached 6,581 children of KPs with HIV testing services. Of these children, 740 were newly diagnosed with HIV, representing a 11 percent case finding rate. Ninety-four percent of those who tested positive were linked to anti-retroviral therapy (ART). EpiC also reached 130,789 clients of female sex workers with testing services, 13,812 of whom were newly diagnosed with HIV, representing a case finding rate of 11 percent. Of those newly diagnosed, 97 percent were linked to ART.  

Reaching children and partners of KPs with HIV services helps prevent new infections by focusing on groups that face a higher likelihood of exposure to HIV but may not typically be reached by HIV programming. Using these approaches brings the world closer to epidemic control by looking at HIV risk through the frame of familial and social ties, instead of only individual identities.    

Key resources: 

This blog is part of a series highlighting EpiC’s technical approaches, key results, tools, and strategies that have driven positive change in HIV outcomes.