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Community Leadership AIDS 2024
Community Leadership as a Key Strategy to End HIV in Asia: Reflections From AIDS 2024

Released: August 14, 2024

Expiration: August 13, 2025

Nittaya Phanuphak
Nittaya Phanuphak, MD, PhD
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • Health services led by key populations are feasible and effective methods to improve HIV care and prevention for these communities.
  • Community-led monitoring initiatives can identify gaps, enhance the quality of healthcare, and address rights and social issues.

In 2023, Asia and the Pacific region accounted for 23% of new HIV infections globally, with people from key populations (men who have sex with men, transgender women, sex workers, and people who inject drugs, and their sex partners) disproportionately affected. But major gaps persist in delivering combination HIV prevention services to those who are in need: Among the 8.2 million people in this region targeted for pre-exposure prophylaxis (PrEP) by 2025, only approximately 5% were reached in 2023. Among countries in Asia with the most advanced PrEP programs, community-led health services were a key PrEP roll-out strategy.

At the 25th International AIDS Conference (AIDS 2024) in Munich, Germany, investigators from Asia and the Pacific showcased exceptional models of community leadership in designing, codelivering, monitoring, and sustaining HIV-related responses.

Key Population-Led Health Services
Since 2015, Thailand has demonstrated the feasibility and effectiveness of involving people from key populations – men who have sex with men, transgender women, sex workers, and people who inject drugs – in delivering health services that usually would be delivered by medical professionals. Data show that this method enhances HIV testing and PrEP uptake, and the success of this approach led to its institutionalization in Thailand’s healthcare system in 2019.

During the past 5 years, community-led organizations in Thailand implemented peer-to-peer capacity building to transfer knowledge and skills in PrEP implementation, integration of substance use and mental health services, and transgender-competent care to other community-led organizations in Asian countries with similar cultural and social contexts. In Laos, this resulted in 1197 new PrEP recipients and identification of key areas in need of HIV testing. In Myanmar, this led to the establishment of 2 transgender-led clinics, serving more than 2000 transgender women annually.

Another notable example of key population-led health services highlighted at AIDS 2024 was the Tangerine Clinic, a transgender-led gender-affirming sexual health clinic in Bangkok. In response to the growing HIV epidemic among youth, the Tangerine Clinic tailored its service to be youth inclusive to facilitate access to HIV prevention and treatment, sexually transmitted infection testing and treatment, and safe hormone use among young transgender women.

And it worked. Tangerine Clinic data showed that integration of sexual health services and youth-inclusive, gender-affirming care facilitated linkage to HIV care and treatment. Almost one half of the 6280 transgender women clients were aged 24 years or younger, and 71% of them reported gender-affirming hormone service as their primary reason for a clinic visit. Even though HIV care was not the primary reason for their visits, 96% of these young transgender women received HIV testing, with almost 90% of those who tested positive receiving same-day antiretroviral therapy, and 20% of those who tested negative for HIV initiating PrEP.

Community Leadership Beyond the Clinic
Despite these successes, community leadership must go beyond delivering community-led health services. Effective monitoring systems must be in place to identify gaps and to create solutions that enhance the quality of healthcare. To this end, a community-led monitoring (CLM) initiative in Thailand successfully used data from online surveys for health system improvement. Upon realizing that 92% of CLM respondents indicated they had limited access to PrEP facilities, the local health office systematically helped all hospitals register to become PrEP facilities.

Similarly, Peduli Hati in Jakarta, Indonesia, and Community Network for Empowerment in Manipur, India – along with amfAR’s TREAT Asia – implemented “CLM in Asia,” a digitalized community-led monitoring platform. Based on responses from recipients of HIV and hepatitis B and C virus care services, CLM in Asia successfully addressed issues of rights and social justice by improving linkage to care, access to medication, and addressing gender-based violence.

And in Thailand, the Foundation for Action on Inclusion Rights successfully established a cadre of community paralegals to deliver rights literacy in their intersectional communities, to monitor and provide case management for legal abusive and rights violation incidents, and to document cases for evidence-based policy advocacy.

Looking to the Future
Community leadership is essential for the region’s HIV response, but community-led responses are severely underfunded and not yet sustainable. At AIDS 2024, representatives from Thailand described how they used international funding as a catalyst to demonstrate feasibility of a transgender-led health service model. They also used community-collected data to drive evidence-based policy change. Concerted community-driven efforts – made by developing trans-competent care guidelines and engaging political bodies to support trans-inclusive policies – were crucial for amplifying the needs and requiring changes. Following Thailand’s general election in 2023, the government announced that they would prioritize gender-affirming care, and they are anticipated to include it as part of Thailand’s Universal Health Coverage within 2024.

Your Thoughts
What lessons can you take or implement from the community-led efforts to improve HIV care and prevention in Thailand? How might these studies inform HIV care in your own practice? Leave a comment to join the discussion!