While limited, studies of men having sex with men and transgender women indicate a vital need for targeted technology-assisted interventions to address their lack of access to care and treatment, the high level of stigma and discrimination, and drug and alcohol use (Breyer, Sullivan, Sanchez, Dowdy, Altman, Trapence, Collins, Katabira, Kazatchkine, Sidibe, & Mayer, 2012; Stroumsa, 2014). In Thailand, a cross-sectional survey to ex- amine and compare sexual risk behaviors, and demographic and behavioral correlates of risk among men having sex with men and transgender women recruited from gay entertainment venues showed one in five used illicit drugs (Newman, Lee, Roungprakhon, & Tepjan, 2012). Other studies have shown a higher use of illicit drug use in men having sex with men infected with HIV (Li, Baker, Korostyshevskiy, Slack, & Plankey, 2012; Wei, Gua- damuz, Lim, Huang, & Koe, 2012) as well as the use of illicit stimulants, such as methamphetamine, in men having sex with men who report depression or sadness (Carrico, Pollack, Stall, Shade, Neilands, Rice, Woods, & Moskowitz, 2012). Screening for alcohol consumption in male sex workers reported 70% consumed alcohol, 40% binge drank, 35% screened for hazardous drinking, 15% harmful drinking and 21% alcohol dependence (Luchters, Giebel, Syengo, Lango, King’ola, Temmerman, & Chersich, 2011). Taken together, these studies show members of keypopulations use and abuse alcohol and/or illicit drugs, experience stigma and discrimina- tion to high degree, as well as, need technology-assisted addiction treatment that can be used to address illicit drug abuse and alcohol use.
that, community-based interventions are also prioritised in which peer educators and outreach workers are mobil- ised in the community. Peer educators are volunteers who convey crucial information (proper condom use, HIV testing, etc) to keypopulations in informal (cruising areas like bus parks or public parks) and formal settings (drop-in centres). They also distribute condoms, safe needles/syringes or make them aware about available treatment, care and support services.
Several real-world issues often limit the implementa- tion of all components of the comprehensive package of services. Such factors range from political will, legal and policy environment, to local capacity and resources. Tracking coverage of keypopulations receiving all the items in the comprehensive package is simply unrealis- tic, as not all items are directly provided to the individ- uals at one time, even within, for example, an annual implementation period. During program implementa- tion, no individual key population member may need all items from the overall package at the same time and with the same frequency. For example, people who inject drugs only may be in need of certain interventions in the package of harm reduction services (such as Needle and Syringe Program [NSP], Opioid Substitution Ther- apy [OST], HIV Testing Services [HTS], etc.) and might not need sexually transmitted infections (STI) services and HIV treatment and care. In addition, not all service providers offer the full list of interventions included in the package. For instance, a specific community-based service provider may not provide these services them- selves but may refer individuals to health facilities for diagnosis and treatment of sexually transmitted diseases. Programs often lack data systems to track individuals across different service providers.
Stigma is related to attributes considered to be strongly discrediting by dominant sections of society [9,11-13]. A perceived deviance, such as same-sex practices or being involved with sex work, result in sanctions that lead to stigma and discrimination within socially defined power situations and are likely to lead to reduced use and access to services by affected communities [11,37,38]. Some Caribbean studies have observed strong associations between discrimination, denial of healthcare services, sexuality-based blackmail, and fear of seeking access to healthcare services [14,15,39]. “The design and delivery of HIV prevention services are limited by a reluctance to reach out to keypopulations. In many countries, they are pushed to the fringes of society by stigma and the criminalization of same-sex relationships, drug use and sex work. This marginalization limits their access to HIV services” .
This study has limitations. These includes reliance on the respondents’ statements, with little opportunity to check their validity and reliability. Also, the study is cross-sectional, so no causality can be adduced to the re- lationship between any action and outcomes. Our find- ings on the barriers to access of health care services by keypopulations may also have been limited in compre- hensiveness. Nevertheless, the study is important for a number of reasons. First, it addressed a research gap in reports to date. Second, it illustrates that concerns about abuse of human rights are not unique to public health facilities. Third, the findings have implications for pro- gramming HIV prevention services for keypopulations. Public health facilities and peer-led organisations serve the needs of keypopulations. It is therefore important that barriers to accessing services in public health facilities be addressed to encourage keypopulations to use the available HIV prevention services. Regular training in eth- ics, confidentiality and medico-legal issues could help im- prove health care delivery in both public and peer-led organisations. On-the-job training of health care providers could improve their listening skills and assurance of client confidentiality. Hospital waiting times could be shortened. These improvements could increase the uptake of services by keypopulations as well as the general public, and they could help in preparing for future integration of peer-led facilities into government-funded systems.
This systematic scoping review will map existing literature on active tuberculosis case finding policies, strategies, and interventions for TB keypopulations globally. The World Health Organization End TB Strategy aims to end the glo- bal TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035, and to ensure that no family is burdened with catastrophic ex- penses due to TB . The WHO has also set interim milestones for 2020, 2025, and 2030 . The End Strategy reinforces a focus on serving populations highly vulnerable to TB infection and poor healthcare access, such as hard-to-reach populations . Populations such as people living with HIV/AIDS, prisoners, migrants, refu- gees, displaced persons, survivors of TB infection, and in- digenous populations have been identified as keypopulations with a higher risk of developing TB illness . We anticipate that the mapped evidence will help reveal diverse active TB case finding policies, strategies, and inter- ventions to help inform future adoption and implementa- tion to reduce TB missing cases worldwide. We also anticipated that the results of the proposed scoping review will help reveal research gaps, which can be addressed to ensure early detection and treatment of TB among keypopulations. The proposed study will may as well contrib- ute to healthcare systems strengthening and improve re- search in TB keypopulations. The study further intends to build and contribute to a body of literature on TB research, particularly on the diagnosis of the most vulnerable popula- tions. Moreover, the results of the proposed scoping review may contribute to eliminating TB by the year 2035.
In Togo, HIV prevalence among keypopulations ranges from 11 to 13% compared to 2.1% in the general population . Data on the prevalence of syphilis are regularly obtained through a sentinel surveillance system which is designed to monitor trends of STI prevalence among pregnant women attending antenatal clinics. Based on this monitoring system, the prevalence of syphilis was estimated at 1.2% in 2011 . This preva- lence was approximately half of that reported the same year using a second-generation surveillance protocol among FSW and their clients with 2.2 and 2.3%, respect- ively . No data on syphilis are available in other keypopulations, specifically among MSM who account for more than 80% of syphilis burden in developed countries [8, 17]. In 2017, we conducted a nationwide study to es- timate the prevalence of syphilis among FSW, MSM and DU in Togo.
Nigeria has the second largest global HIV/AIDS burden and a mixed epidemic driven by low personal risk perception, multiple concurrent sexual partnerships, transactional and inter-generational sex, ineffective and inefficient services for sexually transmitted infections (STIs), and inadequate access to quality health- care  . Though HIV prevalence is on the decline in the general population (3.6% to 3.4%), two episodes of integrated biological and behavioural surveil- lance surveys have identified three keypopulations (KP) namely, female sex workers (FSW), men who have sex with men (MSM) and persons who inject drugs (PWI), with prevalence as high as 22.9% among MSM, 19.4% among bro- thel based FSW and 3.4% among PWID  . In addition, while key popula- tions may constitute only about 1% of the adult population, these high risk groups contribute a significant proportion of the new infections. According to the mode of transmission studies conducted in 2008, FSW, MSM and PWID with their partners contribute as much as 40% of new infections . Therefore, addressing the comprehensive HIV needs of these target populations remains a priority and strategic step towards reversing the spread of the epidemic in Nigeria. Unfortunately, unabated stigma, discrimination, criminalization and hostile homophobic environment, coupled with the pervasive insensitivity of health professionals towards keypopulations have continued to limit access to quality and comprehensive HIV prevention, treatment and care. As a result, key popu- lations often present late for treatment and few are initiated into lifesaving me- dications including antibiotics and ARV treatment. The 2014 Integrated Biolog- ical and Behavioral Surveillance Survey (IBBSS) reported that only 75% of MSW, 60% of PWID and 55% of FSW knew a facility to have HIV testing services (HTS) . This implies that innovative, culturally sensitive and quality service delivery models are needed to reach, test, link and retain KP in care within their communities.
The HTC services were utilized by only a little over a quarter of the keypopulations (29%) identified in this study. The utilization of HTC services varied among dif- ferent population groups around the world. Utilization of HTC services was 94% among health workers in Zim- babwe , 32–63% among university students in Kenya [27, 28], and 87% among men who have sex with men (MSM) in Nepal . However, utilization data among refugees from elsewhere were not found. Interven- tions to increase the utilization of HTC services among keypopulations among the Bhutanese refugees may need further exploration. People who are younger than 25 years use the HTC center at the camps less than those who are 25 years and older. This shows a need for target programs to meet the needs of young refugees. Educa- tion was the only socio-demographic characteristic that was significant in the multivariate analysis. It was nota- ble that illiterate rather than literate refugees used HTC services within the camps more frequently. The find- ings corroborates with the findings from findings from keypopulations in South Africa , where the illiterate people were more likely to utilize the HTC services. The underlying reasons for this phenomenon may need fur- ther exploration, perhaps using qualitative methods.
As the HIV epidemic worsens, social changes are occurring for young people in the Philippines. Increased online connectivity, a growing economy and prevalent mobile device use has changed the way people spend their time and socialise. This change has generated new possibilities for the public health sector to deliver targeted health messages . Utilising technology already popular among adolescents and young adults may provide access to individuals that do not otherwise engage with traditional forms of HIV education and advocacy . Mobile games in particular offer a promising platform to address the knowledge gaps, perceptions, social pressure and self-stigma that deter young keypopulations from accessing health services . A recent meta-analysis of 54 digital games for healthy lifestyle promotion found small but significant effects on behaviour, determinants and clinical outcomes, demonstrating the potential benefits .
Although no global human rights treaty expressly ad- dresses HIV , there are a wealth of norms and prin- ciples in general human rights treaties that are relevant to HIV and to the protection of persons affected by the epidemic, including keypopulations. The international legal frameworks developed since the founding of the United Nations (UN) identify individual rights-holders and their entitlements, together with corresponding duty-bearers and their obligations. Human rights are protected under international law, under regional sys- tems, and by national constitutions . Some of the basic human rights are asserted in the morally binding Universal Declaration of Human Rights (UDHR), adopted in 1948 by the General Assembly of the United Nations. Ghana is a signatory. Founded upon the non- derogable right to life, the UDHR affirms in Article 25/1 “everyone has the right to a standard of living adequate for the health and wellbeing of himself…” . Subse- quent international human rights instruments have not only expanded this, but have also made human rights law legally binding. The International Covenant on Civil and Political Rights (ICCPR)  requires member states to respect and ensure civil and political rights. Codified in the International Covenant on Economic, Social and Cultural Rights (ICESCR), and in line with the WHO Constitution. Article 12 of ICESCR states that “the States Parties recognize the right of everyone to the en- joyment of the highest attainable standard of physical and mental health ” . Building from these standards, a wide range of UN agencies and advocacy groups have increasingly invoked a “ human rights-based approach ” to health as a means to frame the public health policy en- vironment and to facilitate government accountability .
creation of the Global Hepatitis Programme . In 2012, the WHO provided a framework for global action on the prevention and control of viral hepatitis infection . While providing a regional burden of disease, the framework presented a stark picture of hepatitis C infection in keypopulations, specifically for injection drug users, indicating that 60% - 80% of injection drug users, worldwide, are positive for the hepatitis C virus. The comprehensive framework for global action challenges regions and countries to develop specific strategies and plans to address the burden of hepatitis infection with important elements being the screening for hepatitis C in- fection and an increasing access to care and treatment. Critical to the success of these elements, in resource- constrained settings, is the development of national hepatitis policies and care and treatment guidelines promot- ing accessible and affordable hepatitis C treatment. The WHO has recently published initial baseline survey data of 126 Member States, 60 of which were low-income countries, reporting on their comprehensive national re- sponse to hepatitis infection . Only 47 countries report the presence of a written national strategy or plan for addressing hepatitis infection, while 36 Member States have a government unit dedicated to addressing hepatitis prevention, care and treatment. Approximately 90 countries have hepatitis prevention and control programs, but they mostly target health care workers. Sixty-nine counties report hepatitis prevention and control programs for injection drug users. Approximately 50 countries report a chronic hepatitis C surveillance program while 90 countries report surveys of chronic hepatitis infection in keypopulations. Access to care and treatment for hepa- titis C is reported as limited, with 69 countries indicating the availability of pegylated interferon treatment. Ni- nety countries indicate some form of publicly funded hepatitis treatment program. The survey did not report the access and treatment levels for keypopulations.
The primary analysis will involve looking at a synthesis of the burden of HIV and the HIV treatment cascade among keypopulations living with HIV. We will inves- tigate comparisons by population and by country, in particular focusing on comparisons within sub-Saharan Africa and regions within sub-Saharan Africa. We an- ticipate heterogeneity of the data and therefore propose a narrative synthesis. If feasible, we will consider in- cluding a meta-analysis. Secondary analyses will involve looking at reporting of pre-exposure prophylaxis (PrEP) use and PrEP uptake among those who are HIV nega- tive. Similarly, this will involve comparisons across pop- ulations and countries and will involve a narrative synthesis. Additional secondary analyses involving pre- vention indicators (engaged in HIV testing, knowledge of HIV prevention, condom availability, consistent con- dom use), population size estimates, experienced vio- lence (physical, sexual, intimate partner), and engagement with healthcare systems for key popula- tions may be proposed at a later date.
Among criteria elicited by multiple key informants from diverse groups, perspectives of how a criterion is defined sometimes diverged significantly. Feasibility , for example, is a criterion that is often elicited in research prioritization [27, 28, 41]. In our conversations, key informants from the government, NGOs and research institutes defined feasibility in terms of structural en- ablers in place to support the method, such as mobile telephone technology, roads to get to remote villages, and experienced investigators. We call this the systems perspective of the criteria. Key informants from the community of people at risk of HIV, clarified feasibility in terms of the individual recruits’ willingness to partici- pate in the size estimation studies – due to convenience of participation, interest in the novelty of the method and the learning opportunity, and a sense of community or civil duty to their community. We call this perspec- tive the community perspective of the criteria. Another instance in our study where the community and system perspectives are evident, is in the discussions around duration . One key informant spoke about duration from the perspective of an individual survey taker (community perspective), while another took the perspective of the entire duration of a size estimation study (system per- spective). Our study points out the importance of this dual perspective to help decision-makers derive a more complete and legitimate definition of the criteria.
4. The programmer can then change the entries in the WIBU-BOX as he desires or as his customer wishes. He uses the WIBU-KEY software WKCRYPT and references the provided Context File as the WIBU-BOX to program. If there are entries in the box with different Firm Codes, the programmer can only change the entries with the Firm Code for which he has the corresponding FSB and WKFIRM.WBC. This makes the WIBU-KEY Remote Programming an absolutely secure operation. The new file is called the Update File. It contains the appropriate management information for the specific WIBU-BOX, as well as the commands that implement the changes specified by the software developer. This file is then sent back to the customer. 5. The customer double-clicks the Update File or reads it into his WIBU-BOX
, however, are not uniform, but rather take on different characteristics and paths depending on the types of engagement practices that various biobanks undertake in their operations. In addition, we see the process of bio- objectification as an iterative process between historical, political and scientific activities where these different spheres interact with each other in different configurations and ways. The process of bio-objectification gives rise to forms of legitimation through which local, regional, national and supra—national actors seek to leverage and utilize samples in a more efficient way. We see this process contributing to the politicization of populations in Europe and elsewhere, whereby groups of people are ascribed particular types of char- acteristics (not only in a medical sense, but also in a public opinion and political action meaning as well) in relation to engagement and biobank perspectives, as opposed to un- derstanding public opinion and perceptions as being fluid and changing over time, requir- ing regular interaction and dialogue (Tupasela Aaro: Branding populations in medical research – placing genes on the global genetic atlas, submitted).
If an explanation of how the governance of populations is consistent with liberal freedoms is not to be found here, what remains of interest is Foucault’s attempt over twelve lectures to frame the question. An obvious way in which he might have approached the problem, but chose not to, is through conceptual analysis. His assertion that ‘universals do not exist’ (3) in the history of ideas suggests that an extensive analysis of the logical consistency of ‘liberalism’ and ‘biopolitics’ would have been contrary to his method. He insists on not using ‘all those universals employed by… political philosophy in order to account for real governmental practice’ (2) and sees liberalism ‘not as a theory or ideology’ but simply as ‘a way of doing things… regulating itself by continuous reflection’ (318). However, in the absence of any philosophical analysis of the key concepts of liberalism and biopolitics (based on stable definitions), one cannot see how Foucault could have known when his main question had been satisfactorily answered. His method appears to leave him unable to identify a system of government as liberal in the first place, and subsequently unable to assess the compatibility of biopolitics with the liberal ideas of that system. Given the range of perspectives from which liberalism was contested throughout the 20 th century, Foucault’s assumption that a dominant governmental practice (i.e. biopolitics) must be consistent with liberalism begs an obvious question. Is biopolitics perhaps the effect of a non-liberal theory of government? Is liberalism actually the ‘general framework of biopolitics’ (22) as he claims, or are there more plausible candidates among the political ideas of Foucault’s time? These elementary questions are left unconsidered in these lectures.
Prions are the infectious proteins responsible for spongiform encephalophaties such as mad-cow disease. These misfolded proteins can convert functional cellular proteins with the same amino acid sequence into adopting their conformation (general three-dimensional shape or folding) (Prusiner 1999). While the precise mechanisms by which conversion proceeds are still debated, a template transmission process is often assumed (Shorter and Lindquist 2005). According to this hypothesis, the ‘normal’ cellular protein (either folded in its functional state or in a transiently unfolded state) is recruited by an agglomeration of prions (forming amyloid sticks), which then misfolds the protein into the prion form. While prions can transmit their conformation to other proteins, the converted proteins are products of mRNA translation. Protein multiplication thus occurs without the normal cellular protein or the prion participating in their material production. Inhibiting the gene responsible for the protein terminates prion conversion since prions depend on prior proteins to transmit their form (Chien, Weissman, and DePace 2004). Prions can also come in many variant strains differing both in their conformational structure and in their intra- and extra-cellular phenotypic effects. It has been argued that these strains can compete against one another and the normal cellular form, a competition leading to a process of Darwinian evolution of these strains (Li et al. 2010). So populations of prions can in principle evolve through natural selection even though they do no form parent- offspring lineages when multiplying.