"We began our work around key population-led health services in 2014 with the support of US President's Emergency Fund for AIDS Relief (PEPFAR) and United States Agency for International Development (USAID). We selected key population organisations in four provinces; we trained and equipped them with the instruments so that they could do HIV testing, CD4 cell count testing, and deliver PrEP and antiretroviral therapy. They were working together with the local doctors and public health officials to ensure that the service quality is good enough," said Dr Praphan Phanuphak.
Dr Praphan-led team generated scientific evidence on effectiveness of key population-led HIV and health services and submitted it to the Ministry of Public Health of Thailand. "This led to formal legalisation and approval that well trained people from key populations can work in parallel with the public health officials in Thailand to deliver certain important HIV services. This legalisation made it possible for this effort to be financed by Thai government. However, lately this success had intermittent interruptions due to misinterpretation and misunderstanding of this effort," said Dr Praphan.
A stereotype and harmful narrative needs to be dismantled. "Our Asian concept is that 'health has to be delivered by healthcare workers' - so paternalism and hierarchical nature of health system results in unequal power between doctors and other providers. This has to be firmly nailed down. Key population-led services are accepted worldwide and have to be expanded widely in the country," rightly emphasised Dr Praphan.
Communities-led responses have made a difference in Nepal too
Nepal is among the four countries worldwide that has reduced new HIV infections by over 75% by 2023 (compared to 2010): the other three nations are Kenya, Zimbabwe and Malawi.
According to the latest UNAIDS report of 2024, Nepal's decline in new infections by 2023 was 79%.
"Community-led interventions that are by - and for - the communities have made a difference in Nepal," says Sara Thapa Magar, President of National Federation of Women Living with HIV and AIDS (NFWLHA) in Nepal, who also represents International Council of Women living with HIV (ICW) in Asia and the Pacific region. "We have to educate our own community members to lead targeted interventions to serve people living with HIV. 100% HIV testing of pregnant women in Nepal, rollout of PrEP, or focus on #UequalsU has made an impact too."
Call to choose public health and not criminalisation in Papua New Guinea
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