Thailand’s community-led HIV revolution is powered by #PutPeopleFirst : Shobha Shukla – CNS

As the world grapples with the final stretch toward the 2030 goal of ending AIDS as a public health threat, Thailand’s Key Population-Led Health Services (KPLHS) delivery model stands out as a beacon of innovation, equity, and proven impact.

Dr Nittaya Phanuphak, Executive Director of the Institute of HIV Research and Innovation (IHRI) Thailand, posed a pointed question to global health leaders, policymakers, and advocates: Do you know why community-led health services for HIV key populations are critically vital?

Her answer, rooted in more than two decades of pioneering work in Thailand’s HIV response, underscores a fundamental shift from top-down, facility-centric models to people-centred, rights-based approaches that place affected communities at the heart of service design and delivery.

Dr Phanuphak was among the opening keynote speakers of an 26th International AIDS Conference (AIDS 2026) Affiliated Independent Event organised by CNS and partners under the banner #RethinkRebuildRise and #PutPeopleFirst to end AIDS and TB in next 54 months (by 2030),

KPLHS bridge the gap that conventional health systems cannot

She highlighted how KPLHS bridges critical gaps that conventional health systems often cannot reach – particularly for key populations disproportionately affected by HIV, including gay men and other men who have sex with men, transgender women, sex workers and their clients, and people who inject drugs. These groups face intersecting barriers of stigma, discrimination, criminalisation, and distrust of mainstream services.

“Key Population-Led Health Services (KPLHS) are designed and co-delivered by key populations themselves,” Dr Phanuphak explained in related discussions. “They are needs-based, demand-driven, and client-centred. Services are identified by the community, delivered by trained lay providers who are often members of those same communities, in close partnership with public health facilities.”

KPLHS making a difference for over a decade in Thailand

Thailand’s journey with KPLHS began around 2015. The model emerged from grassroots demands by key population communities who recognised that “one-size-fits-all” approaches were failing to curb new infections and ensure treatment access.

Lay providers – peers trained and qualified – perform a range of essential services: HIV and STI testing, pre- and post-test counselling, specimen collection, linkage to lifesaving antiretroviral therapy (ART), dispensing of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), and ongoing retention support. A 2019 regulation from Thailand’s Ministry of Public Health formalised these clinical roles, marking a significant policy win.

The results speak volumes. Thailand boasts one of the largest PrEP rollouts in the Asia-Pacific region, with community-led clinics serving a major share – often cited around 60% or more – of PrEP users nationwide. Earlier diagnosis, stronger linkage to care, and high viral suppression rates have been documented in KPLHS sites compared to traditional facilities. For instance, median CD4 counts at diagnosis tend to be higher, reflecting better outreach to those who might otherwise avoid clinics.

Expanding KPLHS model beyond HIV

Dr Phanuphak has been instrumental in expanding the model beyond HIV to integrate services addressing chemsex, mental health, substance use, gender-based violence, and transgender care. The Tangerine Community Health Center, which she helped establish, exemplifies this holistic approach, bringing thousands of transgender individuals into care.

She calls for radical integration of community-led services into primary healthcare and universal health coverage (UHC) frameworks. “We cannot deliver on UHC unless we reach the unreached through rights-based, people-centred care,” she has emphasised.

This includes integrating HIV with STI care, viral hepatitis, TB, mental health, and non-communicable diseases. Community models are uniquely positioned to deliver holistic, client-centred care that addresses the full spectrum of needs.

Legalisation and financing through Thailand’s UHC scheme represent game-changing progress, allowing community organisations to register as service providers and receive direct reimbursement. This sustainability model is one that many countries could emulate as donor funding landscapes shift.

Nuttapat Wajasuwan of MPLUS Foundation Thailand also emphasised on critical importance of community-led health service delivery model in Thailand especially when it comes to serving the key populations with equity, rights and dignity. Nuttapat also underlined the need for integrated HIV-TB services that are accessible and stigma-free. He called for greater investment in community-led services to deliver high-impact interventions. MPLUS Foundation and similar groups are bridging gaps in HIV and TB testing, linkage to care, and support services.

Yet challenges persist. Integration into the national public health system remains incomplete. “Despite successes, we have faced hurdles over the last decade,” Dr Phanuphak noted in interviews. “Key population lay providers continue to be the primary initiators and maintainers of PrEP services for their peers. We need full accreditation, sustainable domestic financing, and reimbursement mechanisms to ensure longevity.”

Why community leadership matters

Community-led responses are not a luxury – they are a necessity for achieving the UNAIDS 95-95-95 targets and broader Sustainable Development Goals (SDGs), particularly SDG-3 on good health and well-being. Global strategies repeatedly affirm that communities must lead in service delivery, monitoring, and accountability.

Peer-led services build trust where fear and stigma prevail. They reduce barriers related to confidentiality, judgment, and cultural insensitivity. Evidence from Thailand and beyond shows community-led health service delivery models achieve comparable or superior outcomes in testing uptake, ART initiation, retention, and viral suppression.

KPLHS makes same day PrEP and ART initiation possible

In Thailand, KPLHS has enabled same-day PrEP and ART initiation through collaborations between community-based organisations and hospitals, aligning with national guidelines updated in 2020. Community-led monitoring has also driven systemic improvements, such as expanding PrEP facility registrations based on real user feedback.

From a rights-based perspective, this approach advances equity and justice. It empowers marginalised groups, reduces intersectional stigma, and promotes U=U (Undetectable equals Untransmittable) as both a scientific fact and a tool for dignity. Dr Phanuphak strongly advocates embedding human rights and legal support within these services.

Invest in community leadership not as an add-on, but as a core strategy

Thailand’s experience demonstrates that when communities lead, responses become more effective, acceptable, and sustainable. Legalising and resourcing KPLHS has been a game-changer, protecting those most at risk while advancing national and global goals.

For governments, donors, and international bodies, the message is clear: invest in community leadership not as an add-on, but as a core strategy. Scale proven models, remove legal and policy barriers, ensure fair financing, and integrate services for maximum impact.

“In many parts of our region, new HIV infections continue, particularly among young gay men and other men who have sex with men. We are only reaching a small fraction with oral PrEP – less than 3% in some contexts – and long-acting injectable options are still out of reach for most due to cost, policy, and access barriers,” said Numan Afifi, Programme and Advocacy Lead, APCOM.

“Community-led responses are proven and must be at the centre. APCOM and our partners have demonstrated that peer-led services build trust, reduce stigma, and deliver results where formal systems fall short. We need to scale these high impact community-driven interventions, such as, demand generation through digital tools and apps, community monitoring, integrated services addressing chemsex, mental health, and rights violations,” said Numan.

“Punitive laws, criminalisation, and stigma continue to drive people underground. We call for decriminalisation, meaningful community engagement in national programmes, and sustainable financing – not just applause in meetings. As we head to AIDS 2026 in Rio de Janeiro, Brazil, governments must honour commitments in the Political Declaration adopted in June 2026: fully fund key population-led interventions, protect rights, and leave no one behind, including in challenging contexts like Afghanistan, Myanmar, and Pacific Islands,” he said.

As the clock ticks toward 2030 – with roughly four years remaining – Dr Phanuphak and partners stress the need for accelerated action. “We have the science-based tools. What we need is the political commitment and investment in communities to deploy them effectively at scale.”

The next 54 months will test global resolve. The communities demonstrating strongest impact on the frontline are ready to lead and scale up – if given the political and financial prioritisation and fair resources and spaces to do so. The world cannot afford to leave them behind.