Ehancing HIV and sexual health care: For key populations in sub-Saharan Africa and the Netherlands

Since the beginning of the HIV epidemic, certain groups, such as transgender individuals, sex workers, and men who have sex with men (MSM), are at higher risk of contracting HIV. This is not only due to their sexual behavior but also because of exclusion, stigma, and discrimination, which limit their access to healthcare. We call these groups "key populations". This dissertation explores how HIV and sexual health care for key populations can be improved in both Sub-Saharan Africa and the Netherlands.

Research shows that HIV is significantly more prevalent among MSM and transgender women in Sub-Saharan Africa than in the general population. HIV prevalence is also considerably higher among male sex workers. In the Netherlands, sex workers faced significant challenges during the COVID-19 pandemic, including financial problems, reduced access to care, and an increase in violence. Sex workers received little government support, exacerbating their situation.

The studies emphasize the urgent need to tailor policies and healthcare to meet the specific needs of key populations. The research concludes that HIV causes a disturbingly high disease burden in Sub-Saharan Africa, access to care for both trans and cisgender sex workers is severely lacking in Zimbabwe, and COVID-19 measures in the Netherlands had major negative impacts on sex workers. The dissertation advocates for more inclusive care and policies that address the potential vulnerable position of key populations.