Background: Since 2004, the Resource Tracking for HIV Prevention Research and Development (R&D) Working Group (AVAC, IAVI & UNAIDS) has tracked resource trends in R&D for new HIV prevention options. A 2018 UNAIDS report found that 47% of new HIV infections globally, or 850,000 in 2017, were among key populations and their sexual partners. A licensed HIV vaccine effective in all populations?even if current candidates in trials prove effective?is at least five years away.
Methods: For 2017, the Resource Tracking Working Group tracked R&D investment in HIV prevention, and AVAC tracked oral PrEP implementation through the Prevention Market Manager Global PrEP Tracker. Data were collected on annual global disbursements for product development, clinical trials and trial preparation, community education, and policy advocacy to estimate annual non-vaccine investment in HIV prevention R&D directed specifically toward key populations. Funding was categorized based upon grant descriptions of work pertaining to men who have sex with men (MSM), sex workers, transgender people, and people who inject drugs (PWID).
Results: In 2017, of $228 million invested globally in microbicides, pre-exposure prophylaxis (PrEP), and treatment as prevention (TasP) R&D, $14.6 million, or 6%, was devoted to research expressly directed toward key populations. This represents 2.3% of funding for research on microbicides, 17% for PrEP, and 4% for TasP. Among key populations, out of a global HIV non-vaccine prevention research portfolio of $281 million, $3.5 million was allocated to prevention research for transgender people, $1.8 million for PWID, $0.6 million for male sex workers, $8.7 million for MSM, of which $2.5 million was allocated for Black or Latino MSM.
Conclusions: The level of investment in key population-specific prevention research suggests the field is not sufficiently resourcing the necessary intersection of biological risk, preferences, and social determinants that affect uptake and effectiveness of new prevention options. Research in key populations is critical to inform development of prevention interventions with positive public health impact, effectively engage civil society in product development, and implement human-centered design research, yet it remains an underfunded and underutilized tool.