Stevens, O., Sabin, K., Garcia, S. A., Anderson, … Imai-Eaton, J. W. (2024). Key population size, HIV prevalence, and ART coverage in sub-Saharan Africa: systematic collation and synthesis of survey data, 2010-23. Lancet Global Health, 12. https://doi.org/10.1016/S2214-109X(24)00236-5

All data used in this analysis can be downloaded here

Key population HIV programmes in sub-Saharan Africa (SSA) require epidemiologic information to ensure equitable and equal access to services. We consolidated survey data among female sex workers (FSW), men-who-have-sex-with-men (MSM), people who inject drugs (PWID), and transgender people to estimate national-level key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for mainland SSA.

Key population size estimates (KPSE), HIV prevalence, and ART coverage data from 39 SSA countries between 2010-2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban KPSE as a proportion of the gender/year/area-matched 15-49 years adult population. We modelled subnational key population HIV prevalence and ART coverage with age/gender/year/province-matched total population estimates as predictors.

We extracted 2065 key population size, 1183 HIV prevalence, and 259 ART coverage data points. Across national urban populations, a median of 1.65% of adult cisgender women were FSW, 0.89% of men were MSM, 0.32% of men injected drugs, and 0.10% of women were transgender. HIV prevalence among key populations was, on average, 4 to 6 times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across SSA, key populations were estimated as 1.2% of the total population aged 15-49 years but 6.1% of people living with HIV.

Key populations in SSA experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates.