Demedicalisation of HIV interventions to end HIV in the Asia–Pacific

Abstract

Despite the challenges to the HIV response in the Asia–Pacific, a demedicalisation of HIV intervention has been demonstrated to be an important strategy to maximise the uptake of HIV prevention tools among key populations in this region. Demedicalisation of HIV interventions translates medical discourse and shifts the paradigm from a disease-focused to a people-centred approach. It also recognises real-life experiences of key populations in the HIV response by empowering them to voice their needs and be at the forefront of the epidemic control. We further categorise a demedicalisation approach into three frameworks: (1) the demystification of clinical or medical concerns; (2) the destigmatisation of people living with HIV; and (3) the decentralisation of healthcare services. This article reviewed the demedicalisation framework by looking at the HIV intervention examples from countries in the Asia–Pacific, which included: (1) a study on drug–drug interaction between pre-exposure prophylaxis and feminising hormone treatment for transgender women; (2) the roles of key population-led health services; and (3) certification of key population lay providers.

Cost-effectiveness and impact of pre-exposure prophylaxis to prevent HIV among men who have sex with men in Asia: A modelling study

“…Cost-effectiveness will not be the only consideration when contemplating PrEP implementation and scale-up as reaching elimination targets may require delivery and availability of PrEP to reach those most in need, at any cost. COVID-19 has spurred further differentiation and simplification of PrEP service delivery in Asia—including offering PrEP through key population owned community clinics, distribution through primary health care, as well as through telehealth and mobile services [ 56 , 57 ]. Due to enabling of refill collection and reduced stigma-related barriers, PrEP refills collected by peers or delivered by community health workers can facilitate increased demand for PrEP [ 7 ].…”

Caring for the whole person: transgender‐competent HIV pre‐exposure prophylaxis as part of integrated primary healthcare services in Vietnam

“…While CQI‐PDSA efforts described in this paper equipped KP‐led clinics to offer transgender‐sensitive and ‐competent care, a critical next step will be the establishment of transgender‐led and ‐owned clinics providing differentiated care [ 17 , 18 ]. The 2020 MOH transgender HIV services guidelines will be vital in enabling comprehensive gender‐affirming services to be available on a larger scale.…”

Long-acting preexposure prophylaxis in low- and middle-income countries: key considerations for implementation

“…A different clinical environment from oral PrEP is required, with access to clean needles and syringes, and hazardous waste disposal, further complicating decentralization of LA-CAB service delivery. In many LMIC, PrEP services are decentralized, and/or delivered by lay providers in community-based clinics, and this decentralization, demedicalization, and simplification of PrEP programming has been shown to increase efficiency and uptake [22 ▪▪ ,45 ▪▪ ]. For example, in Sub-Saharan Africa several national PrEP programs have streamlined PrEP service delivery through decentralization [22 ▪▪ ,46 ▪ ].…”