Rena Janamnuaysook, Institute of HIV Research and Innovation, Thailand, writes:
Key population-led organizations have historically been a major contributor to the success of PrEP rollout in Thailand [1]. Over 80% of current PrEP users in Thailand receive PrEP at key population-led clinics across the country [2]. This is a testament to the strengths of key population-led organizations in enhancing equity in HIV prevention service delivery to key populations.
However, in December 2022, the Ministry of Public Health denounced key population-led organizations to dispense same-day PrEP at their clinics. Regaining their ability to provide PrEP requires entering into a contract with a government hospital and surrendering their PrEP-dispensing authority to the public health facility. Thousands of current and future PrEP clients of these key population-led clinics will now have to refill or start PrEP at government hospitals, no matter the distance or cost.
This announcement will have a massive detrimental impact on Thailand’s national PrEP programme. It will reintroduce logistical barriers to accessing HIV prevention for key populations, leading to further delays in achieving the 2030 goal of ending AIDS as a public health threat, nationally and globally. The government’s disregard for the importance of key population-led organizations in the national AIDS programme has never been more apparent. This is despite global recognition that the adoption of key population-led health services has been an accelerator and a solution to delivering differentiated PrEP services. The World Health Organization (WHO) recommends key population-led services and community-based PrEP; WHO has also profiled success stories from Thailand.
PrEP and other HIV prevention services should and must be accessible anywhere – from government or private hospitals and key population-led clinics – regardless of their registered healthcare schemes. Facility and eligibility discordance prevented life-saving access in the past, and we should strive to never repeat it.
In Thailand, the government health system has a labour shortage, and key populations often face stigma and discrimination within healthcare settings. Therefore, reducing access to PrEP to only government facilities will further diminish already-limited access to healthcare for members of key populations.
The recent change in policy by the Ministry of Public Health and the National Health Security Office is not an acceleration but a deviation away from a well-orchestrated strategy to ending AIDS as a public health threat in our lifetime. Equitizing HIV services for key populations in Thailand has become even more challenging against this policy backdrop. Moreover, the recent decision by Thailand’s government jeopardizes the country’s leadership role in the regional HIV response.
[1] Phanuphak N, et al. Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand. Sex Health. 2018 Nov;15(6):542-555. doi: 10.1071/SH18065. PMID: 30249317.
[2] Lertpiriyasuwat C, et al. AIDS2022, Canada, abstract#OAE0405.
