This toolkit was developed to help program implementers, particularly CBOs and others working in direct service delivery, to more effectively address safety and security challenges within their implementation of HIV programs for and with key populations. It is designed for use in hostile environments; for example, where members of key populations are criminalized and face elevated levels of stigma, discrimination, and violence. It seeks to amplify good programming through identifying and cataloging promising practices and tools, making overarching recommendations to address safety and security challenges, and providing a systematic approach (via checklists) to identify and respond to one’s own safety and security gaps. It also clearly describes the context in which safety and security investments are needed and the importance of these investments for an effective HIV response.

In 2017, the International Treatment Preparedness Coalition (ITPC) embarked on an initiative to develop and implement innovative community-led demand creation solutions for access to and use of oral pre-exposure prophylaxis (PrEP) of HIV by key populations. This initiative included a preliminary literature review of global community perspectives on PrEP, the Community-led Consultative Think Tank Meeting on PrEP, and development of the Key Population Activist Toolkit on PrEP. This document includes the seven points that were developed from this consultative process and articulates key PrEP messages from key population networks and PrEP experts.

This toolkit focuses on preventing HIV among key populations – sex workers, people who inject drugs, transgender people, and gay men and other men who have sex with men. Globally, key populations are 10-24 times more at risk of contracting HIV than adults in the general population In 2015, infections among key populations accounted for 36% of all new infections. There are three main aims of this toolkit:

• To equip community activists with the knowledge and skills that they need around PrEP, advocacy and community mobilization so that they are able to mobilize their communities to demand PrEP
• To enable community PrEP activists to advocate with their governments and service providers to allow key populations access to PrEP services
• To ensure that these services are provided in a manner that is affordable, appropriate to their needs, and addresses access barriers.

To discuss key considerations of PrEP implementation across key population groups, and develop strategies and solutions on community-led KP demand creation, the International Treatment Preparedness Coalition (ITPC) hosted a global community-led consultation on PrEP. The two-day event brought together more than 45 participants from 20 different countries representing civil society, key populations, governments, and technical expert groups. Open discussions and working groups focused on key considerations of PrEP implementation across key population groups, and the development of innovative strategies to create better access to PrEP for communities.