Africa’s Key Populations Demand Bold Action, Not Empty Promises

Read the declaration in French, Swahili, Portuguese, or Arabic.


We are Africa’s key populations: gay and bisexual men and other men who have sex with men; trans and nonbinary people; sex workers of all sexual orientations, gender identities, and expressions; and people who use and inject drugs. And, we stand in solidarity with Africa’s lesbian, bisexual and queer women and intersex people excluded from targeted HIV prevention and treatment interventions. We convened on the sidelines of the 22nd ICASA, in-person in Durban, and virtually, and we reflected and agreed thus:

Our national governments; PEPFAR; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the UN family; and private and public foundations are failing us: criminalized, marginalized and excluded populations. And not only us—but our sex partners, our children, our communities too. The off-track AIDS response reveals this. And we are demanding nothing less than a revolution in the response to the epidemic in our communities.  

62% of new infections are among key populations and their sex partners. Gay men and other men who have sex with men, sex workers and people who use drugs face a 25–35 times greater risk of acquiring HIV, while trans women face a 49 times higher risk. Data from Zimbabwe suggest a 38% prevalence in trans men sex workers. HIV in trans men remains understudied, leading to the assumption that they bear little virus burden.

Current data on the impact of HIV in Africa’s key populations is scarce, and data on Africa’s lesbian, bisexual and queer (LBQ) women and intersex and trans people is non-existent, resulting in unequal HIV responses. Worse, donor funding earmarked to address HIV in LGBTI communities does not include targeted initiatives across all of these subpopulations. Similarly, sex workers’ funding often excludes men and trans sex workers. Overall, we need donors to be accountable, inclusive, responsive, and flexible to adapt to the dynamic and evolving needs of key populations. 

Only 2% of all HIV funding and 9% of resources for prevention are spent on key populations. These miniscule funding levels are a disgrace. New funding initiatives like the U.S. government Key Populations Investment Fund (KPIF) were created to transform this crisis but ended without any follow-up strategy or vision by PEPFAR. We cannot stand for this any longer. There will be no “end to AIDS by 2030” without major funding increases for our communities, without prioritization of direct investment in community organizations led by us, and without eliminating all forms of discrimination that we experience. 

Data show that HIV responses are undermined by harmful laws. For example the criminalization of same-sex sexual conduct, sex work and drug use is associated with 18%–24% worse knowledge of HIV status and viral load suppression. Countries with laws advancing non-discrimination, and addressing gender-based violence, have better health outcomes, and are associated with significantly higher knowledge of HIV status and viral suppression among people living with HIV. Non-discrimination protections were associated with 9.7% higher knowledge of HIV status and 10.7% higher viral suppression among PLHIV. Gender-based violence laws were associated with 15.9% higher knowledge of HIV status and 16.2% higher viral suppression.

The COVID-19 crisis has poured fuel on this fire. African states have used lockdown to intensify state violence against us. And we have suffered from national lockdowns and restrictions that have made us even more vulnerable to hate, discrimination, and stigma. The COVID-19 crisis has strained funding for AIDS, and it is important that states engage in mitigating the harms of the COVID-19 crisis while securing the paradigm shifts in global treatment and vaccine access needed to respond to COVID-19 while powering and protecting funding and political focus on the response to global AIDS. 

For far too long key population programs have been designed and implemented without accountability to key populations, disregarding our lived experiences, and expertise. In fact, many PEPFAR implementing partners exploit our dedication and labor, paying us virtually nothing for doing the real work of linking key populations to prevention and treatment. No more. And virtually no global funding is being spent on advocacy to dismantle the structural drivers of these inequitable outcomes.

We, Africa’s Key Populations, demand: 

More money to fund the fight against HIV in key populations

  1. Donors increase funding for HIV responses in key populations in low and middle-income countries, to reach at least $1 billion yearly, channeled through a large, stand-alone key populations funding stream, starting with at least $200 million per year in a PEPFAR strategic initiative; creating a surge in new funding dedicated to closing treatment and prevention service delivery gaps, fixing harmful law and policy, mitigating violence, and delivering the community empowerment key populations need
  2. Donors fully invest in key populations-led service delivery, particularly in legally restrictive settings; ensuring linkage to and retention in care, and people-centered care provided with respect and dignity
  3. Donors invest in mental health care as an essential component of HIV service delivery—encompassing both social and medical dimensions to mental health care

Investment in raising the institutional capacities of KP-led CSOs

  1. Donors invest in financial and institutional capacities development of Africa’s key populations-led organizations to improve their eligibility for direct funding, and staff and general operating support

Decriminalization, and funding for human rights advocacy

  1. National governments immediately commit to, and donors fully invest in, the decriminalization of key populations, and interim steps to address human rights barriers to healthcare access, including: the non-enforcement of current bad laws and policies, and protecting open civil society organizing spaces

Better funding criteria, strategies, and expectations

  1. Donors review eligibility criteria for key populations program funding  to ensure implementing organizations have demonstrable track records in key populations-targeted service delivery, and human rights, and that their management, and governance structures center impacted communities
  2. Donor governments, multilateral agencies, foreign missions, and private foundations commit to broad consultations with impacted communities when reviewing funding strategies, and when developing guidelines for funding transition, in order to ensure successful programs continue to receive funding
  3. Donors create and enforce mandatory ethical minimum standards for all key populations service delivery partners, with the multi-sectoral endorsement of key donor governments and private foundations, ensuring key populations programs are accountable to impacted communities, and that harmful, discriminatory, and exploitative programs are cancelled at whatever level, without exception

Dignity, quality, and accountable healthcare

  1. Donors shift from yield-/targets-driven only approaches to people-centered approaches to funding so that service delivery targets do not not come at the cost of service quality, human rights, or dignity
  2. National governments and donors end program and funding approaches that are not based on evidence, that violate human rights, and that increase vulnerability to violence, such as targets for index testing, and using biometrics in countries where key populations still suffer criminalizing laws
  3. National governments and donors meaningfully engage communities in the design of differentiated service delivery models, drawing on the expertise and innovation of successful community models
  4. Donors fully fund and expand the role, leadership, and engagement of key populations in oversight and accountability of major donor government funding for HIV, through community-led monitoring
  5. Donors invest in the review of monitoring and evaluation frameworks for HIV, with meaningful engagement of impacted communities, in order to better assess the impact of funded programs
  6. National governments should proactively identify and engage, and donors should request, key populations at all levels of decision making concerning health policy and strategy, and medicines and commodities supply chain management; ensuring real time oversight and accountability

Better evidence for programming

  1. Donors fully invest in key populations-led research agenda 
  2. Donors fully invest in the collection of epidemiological data on HIV incidence and prevalence in Africa’s LBQ women, intersex, and trans people, and of their sexual and reproductive health needs
  3. National governments and donors should deploy HIV program data collection and reporting approaches disaggregated by sexual orientation and gender identity, engagement in sex work, and use of drugs, in order to appreciate the diversity of key populations and their overlapping risks and needs, and in order to track access to services, medicines and commodities by these subpopulations
  4. Further, national governments should include, and donors should request, disaggregated key populations’ data in key national data tools, including Data Health Information Systems (DHIS), Demographic and Health Surveys, and population census, in order to continuously generate the evidence and data for people-centered health programs

Endorsers include (in alphabetical order, in formation):

  1. Action Group for Health, Human Rights and HIV/AIDS (AGHA), Uganda
  2. Alliance congolaise des droits humains projet travail du sexe (ACODHU-TS), RD Congo
  3. Amkeni Malindi Organization, Kenya
  4. Africa Network of People who use Drugs (AfricanPUD)
  5. African Sex Workers Alliance (ASWA)
  6. Arab Foundation for Freedoms and Equality (AFE)
  7. Arms To Lean On (ATLO), Kenya
  8. ATHENA Network
  9. ASSCODECHA (Community Association for Human Development), Mozambique
  10. AutaMaimasa Health Foundation, Nigeria 
  11. AVAC
  12. Bar Hostesses Empowerment Support Program, Kenya
  13. Blissful Minds, Kenya
  14. Botswana Network on Ethics, Law & HIV/AIDs (BONELA)
  15. Burundian Association for Women in Action (BAWA)
  16. Busia Survivors Organization, Kenya
  17. Coalition de l’Afrique de l’Ouest et du Centre pour le travail du sexe, CAFOC-TS, RD Congo
  18. CENTA, Tanzania
  19. CONERELA+, RD Congo
  20. Consolation East Africa, Kenya
  21. Denis Nzioka News Agency & Service, Kenya
  22. Eagle Wings Youth Initiative, Tanzania
  23. East Africa Sex Workers Alliance (EASWA)
  24. Empowered Ladies Initiative for Equality (ELITE), Kenya
  25. Empowering Marginalized Communities (EMAC), Kenya
  26. Focus for the Future Generations (2FG), Tanzania
  27. Freedom and Roam Uganda (FARUG)
  28. Gala Initiative, Uganda
  29. GALZ—an Association of LGBTI People in ZImbabwe
  30. Gay Bisexual Men HIV Prevention Network (GHPN Ke), Kenya
  31. Global Coalition of Women Against AIDs in Uganda (GCOWAU)
  32. Global Network of People living with HIV (GNP+)
  33. Global Network of Sex Work Projects (NSWP)
  34. Global Tuberculosis Community Advisory Board (TB CAB)
  35. Golden Women Initiative (GWI), Tanzania
  36. Grupo Este Amor, Dominican Republic
  37. Global Black Gay Men Connect (GBGMC)
  38. Hands of Hope Organization
  39. Health GAP
  40. Homme pour les droits et la santé sexuelle (HODSAS), RD Congo
  41. Health and Rights Initiative (HRI), Uganda
  42. Health Development Alternative Initiative (HDAI), Nigeria
  43. Health Options For Young Men on HIV/AIDS/STIs (HOYMAS)
  44. Humanity First Cameroon Plus, Cameroon
  45. i freedom Uganda Network 
  46. Initiative for Equality and Non Discrimination (INEND), Kenya 
  47. IPROTECT, Kenya
  48. Ishtar MSM, Kenya
  49. Isiolo Satellite CBO, Kenya
  50. International Network of People who Use Drugs (INPUD) 
  51. Justice and Economic Empowerment for Women and Girls Foundation Uganda (JEEWAG)
  52. Kenya Sex Workers Alliance (KESWA)
  53. Kisumu Sex Workers Alliance (KISWA), Kenya 
  54. Kenya Network of People Who Use Drugs (KENPUD)
  55. Kenya Youth Development and Education Support Association (KYDESA) 
  56. Key Populations Consortium of Kenya (KPC)
  57. Key Population Transnational Collaboration  (KP-TNC), Tanzania
  58. Kitui Innovators CBO, Kenya
  59. Kitui Shinners, Kenya
  60. KVP Forum, Tanzania
  61. Lady Mermaid Empowerment Center (LMEC), Uganda
  62. Laikipia Stars, Kenya
  63. Lesbian, Intersex, Trans, and other Extensions 
  64. Love Alliance
  65. Men for Positive Living Support (MOPLS), Kenya
  66. Men in Action Supporting Men (MIASM),  Kenya 
  67. Meru Amazonians, Kenya
  68. MPEG, Kenya
  69. M-POA, Kenya
  70. National Gay & Lesbian Human Rights Commission (NGLHRC), Kenya 
  71. National SOGIE HIV Committee (G10), Kenya
  72. Organisation for Gender Empowerment and Rights Advocacy (OGERA), Uganda
  73. OUT STAR Initiative Busia, Kenya
  74. Pan Africa ILGA
  75. Plataforma Mulheres em Acção, Angola
  76. Rainbow Mirrors, Uganda
  77. SANA Tanzania
  78. SANPUD, South Africa
  79. Scarlet initiative, Uganda 
  80. Serving Lives Under Marginalization (SLUM), Uganda
  81. Sexual Minorities Uganda
  82. Sisonke National Sex Workers Movement, South Africa
  83. Sex Workers Education and Advocacy Task Force (SWEAT), South Africa
  84. Spectrum Uganda Initiatives Inc
  85. SWOP Ambassadors, Kenya
  86. TACEF Tanzania 
  87. TaCHIS Tanzania
  88. Tanzania Network for People who Use Drugs (TaNPUD)
  89. TEDA Malindi, Kenya 
  90. Tharaka Nithi Shiners, Kenya
  91. The Global Interfaith Network (GIN-SSOGIE)
  92. The Taala Foundation, Uganda
  93. Trans and Intersex Rising Zimbabwe 
  94. Trans Este Podemos Avanzar TEPA, Dominican Republic
  95. Treatment Action Campaign (TAC), South Africa
  96. Treatment Action Group (TAG)
  97. Ubuntu Law and Justice Center, Uganda
  98. Uganda Key Populations Consortium, Uganda
  99. Uganda Network of Sex Worker-Led Organisations (UNESO)
  101. UMANDE, RDCongo
  102. Umzingwane AIDS Network, Zimbabwe
  103. Union Gay Internacional (UGI), Dominican Republic
  104. Voices of Women in Western, Kenya 
  105. Voices of Community Action and Leadership (VOCAL-KE), Kenya
  106. WACHA Health, Kenya
  107. Western Kenya Sex Workers’ Alliance (WEKESWA)
  108. Women in Response to HIV/AIDS and Drug Addiction (WRADA), Kenya
  109. Women’s Organization Network for Human Rights Advocacy (WONETHA), Uganda
  110. Women’s Positive Empowerment Initiative (WOPEIN), Uganda
  111. Youth Engage, Zimbabwe
  112. Youth Gate Zimbabwe Trust
  113. Zambia Sex Worker’s Alliance (ZASWA), Zambia

* To add your organization to the list of endorsers, please contact Mutisya or Wanja.