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Community Led PrEP
A Community-led Response: HIV/AIDS and PrEP in Asian Countries  

Released: June 18, 2025

Expiration: June 17, 2026

Jakkrapatara Boonruang
Jakkrapatara Boonruang, MD
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Key Takeaways
  • Community-led organizations are central to achieving global HIV targets.
  • Key populations are redefining healthcare delivery through advocacy and service provision.
  • Sustainability of community-led organizations requires legal recognition, secure funding, and support from healthcare professionals.

The Roles of Communities in the HIV/AIDS Response
Since the discovery of HIV, community responses to the pandemic have undoubtedly been an essential force in driving progress in the field. The UNAIDS policy and goals have emphasized the importance of community involvement in HIV responses, particularly in policy advocacy and service delivery. Last year, the organization called on countries to meet the 30-80-60 community-involvement targets by 2025:

  • At least 30% of testing and treatment services should be delivered by community-led organizations.
  • At least 80% of service delivery for HIV prevention programs serving key populations and women should be delivered by community-led, key population-led, and women-led organizations.
  • At least 60% of programs supporting the achievement of societal enablers should be delivered by community-led organizations.

These targets highlight the critical role of community-led initiatives in the fight against HIV/AIDS and aim to strengthen community-led HIV responses, particularly in countries where community efforts are being overlooked.

However, at the global level many countries in the Asia-Pacific region still have restrictions requiring that HIV services only be provided in healthcare facilities and have overly restrictive eligibility criteria for community-based service delivery. In addition, many countries lack social contracting or other mechanisms that prevent domestic funding of community-led service delivery.

Shifting from Community Engagement to Community Leadership
Rena Janamnuaysook, cofounder of Tangerine Clinic, Thailand, emphasized the importance of key population-led services at AIDS 2022 in Montreal, Canada: “We need to shift the paradigm from community engagement to community leadership in the HIV response: Key populations cannot only be service recipients,” she said.

In many Asian countries, key populations have largely been seen through the lens of social movements as leaders and trailblazers. However, from a public health perspective, they continue to be regarded primarily as service recipients. This passive approach is evident by the lack of community leadership within HIV response programs.

But this perception is being challenged as communities take greater initiative in their own healthcare, such as at Tangerine Clinic in Thailand. By codesigning, coleading services, sharing and shifting tasks with local healthcare professionals (HCPs), some communities in the region exemplify how community leadership might be the key to end the AIDS epidemic.

Examples of Community-led Health Services
In response to growing evidence supporting the need for key population-led health services, Vietnam piloted a program called Prepped for PrEP P4P) in 2017. This initiative fostered collaboration between community-based organizations and pre-exposure prophylaxis (PrEP) clinics. It was later integrated into the national PrEP program, allowing people to access HIV prevention through key population-owned or -led clinics. 

Another example of the key population-led health services was PrEP Princess, a project launched in Thailand in 2016. This demonstration project allowed trained men who have sex with men and transgender community workers to deliver same-day PrEP services in community-led clinics.

It worked. Approximately 1500 men who have sex with men and transgender women were offered PrEP through this program. Retention rates among those who received PrEP at Months 1, 3, 6, 9, and 12 were at least 40%, with near-perfect self-reported adherence. This initiative paved the way for the adoption of a lay provider certification program by the Thai Ministry of Public Health, enabling key population providers to be trained as lay providers with the capacity to prescribe PrEP under physician teleconsultation. Since then, the key population-led model has become the main mode of PrEP rollout in Thailand.

Finally, Tangerine Clinic, the first trans-led community clinic in Bangkok, Thailand was born 9 years ago out of a partnership between the community and HCPs. The clinic was founded to offer safe gender-affirming hormone therapy (which is recognized as the primary healthcare priority among trans and gender-diverse communities from the community consultation) while also increasing HIV testing and PrEP uptake.

This initiative also worked. By 2023, Tangerine Clinic had served nearly 6000 transgender individuals, with 91% undergoing HIV screening. Among those who tested negative for HIV, approximately 30% initiated PrEP.

The clinic continues to uphold its community leadership model by employing and training trans individuals as lay providers, which allows them to offer consultations on hormone therapy, HIV, and sexually transmitted infection-related services under physician supervision.

This model also demonstrates resilience in addressing emerging healthcare issues raised by the community, including mental health, substance use, and access to care for trans youth. In addition to its core services, Tangerine Clinic plays a key role in advocating for policy changes, including the integration of gender-affirming care into the universal health scheme. This policy shift ensures that all trans individuals can access these services free of charge.

The Future of Community-led Initiatives
Ultimately, I believe that the future of community-led initiatives lies in advocacy and provision of services. To this end, there are several community-led organizations that address different issues according to their healthcare priorities across the Asia-Pacific region.

Love Yourself is a community-led organization that focuses on HIV/AIDS issues among men who have sex with men and trans and gender-diverse individuals in the Philippines. Project X is a nonprofit organization dedicated to the well-being of those working in the sex industry in Singapore. Yet even though these community-led initiatives play a key role in the public health sector, their funding is largely dependent on international sources. It is imperative that their local governments recognize the role of these organizations in the healthcare system and provide a safe legal landscape with stable funding to ensure that community initiatives are efficient and sustainable.

Another important effort is the accreditation and certification of community-led responses, which helps ensure standardized care and promotes sustainability of these programs. As HCPs, our recognition of and cooperation with community-led organizations could foster stronger alliances to address stigmatized healthcare issues, including HIV/AIDS. Establishing an interorganizational referral system, providing academic support, and recognizing lay providers as part of the healthcare system could facilitate the assimilation of healthcare and community, resulting in more accessible service delivery.  

Your Thoughts
Do you work with any key population-led organizations in your practice? If so, what role do they play? If not, do you envision a space for them in the future? Leave a comment to join the discussion!

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