The region of West and Central Africa is the most populous on the continent, totaling 340 million people. Countries in the region suffer significant HIV epidemics, which require a continued and comprehensive response. However, a current plateau in funding for HIV is juxtaposed with increasing needs for coverage and imperatives due to the shifting nature of the epidemic. These pose great challenges for policymakers in the region. In this context, the importance of most at-risk populations (MARPs) for HIV has been mentioned repeatedly.

For mixed and concentrated epidemics, a prevention focus on MARPs is requisite and cost-effective, and the focus involves enhanced surveillance as well as targeted interventions. These are essential from the “know your epidemic—know your response” perspective, as well as for “smart investments.” However, much is uncertain about how HIV policy in the West and Central African region responds to the epidemiological and programmatic evidence on MARPs. These questions remain. Are countries aware of what is needed? Are they doing it? What is working? This report is concerned with the first two issues, i.e., sharing a policy perspective on what is needed for MARPs in the region and producing an inventory of what is being done. One of our main concerns is providing evidence on the situation of a “continuum of response” for MARP that also includes treatment, care, and structural change to fully capture all potential benefits.

This report represents the second volume of the overall situation assessment of MARPs in West and Central Africa by the Action for West Africa Region II (AWARE II) Project. This volume focuses on the subject of policy, which involves, among other elements, laws, regulations, and programs. The broadening of a definition of policy beyond these familiar elements in the context of MARPs is an outcome of this report. Overall, this report has two objectives. The primary objective is to create a framework for policy related to MARPs and to use this framework to assess the situation in the AWARE II region. The assessment involves taking an inventory of existing laws, regulations, and programs in the region. The secondary objective is to interpret the inventory and data in order to identify barriers to effective prevention and treatment/care programming for MARPs in the region.