{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T18:23:37Z","timestamp":1763490217151,"version":"3.45.0"},"reference-count":28,"publisher":"CSIRO Publishing","issue":"3","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":175,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Fund","award":["GNT1193955"],"award-info":[{"award-number":["GNT1193955"]}]},{"DOI":"10.13039\/100004417","name":"Global Fund to Fight AIDS, Tuberculosis and Malaria","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Key populations and their sexual partners account for 98% of new HIV infections in the Asia\u2013Pacific region. Despite increased domestic funding for HIV programs, concerns persist about the sustainability of services for key populations as external donor programs wind down, potentially reversing progress and contributing to new infections. This study aims to understand structural, political and institutional barriers to domestic funding for key population\u2013led HIV programming in these countries through diverse stakeholder perspectives, including limitations of procurement processes, budget allocation systems and political will.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed methods approach was utilized, with 60 participants completing an online survey and 145 participating in key informant interviews across four countries in 2022. Stakeholders were categorized according to their organization (government, key population\u2013led, non-government (NGO), and multilateral), with 30 stakeholders per country identified. The same respondents were targeted for quantitative and qualitative data collection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key informant interviews included 60 staff from government organizations, 42 from key population\u2013led organizations, 31 from NGOs, and 12 from multilateral organizations. For the survey (n\u00a0=\u00a060), responses were from key population\u2013led (35%), government (32%), NGOs (23%) and multilateral organizations (10%). Regarding the timeline for increased domestic financing for key population\u2013led HIV services, 45% of participants thought it would take 5\u201310\u00a0years to expand them without reliance on external donors, 25% thought more than 10\u00a0years and 5% thought between 0 and 3\u00a0years. Almost all government and key population\u2013led organization respondents in each country agreed on government funding or purchasing of community-based services across various HIV-related areas, including linkage to treatment and antiretrovirals (92%), HIV self-testing (95%), PrEP (80%), and stigma-reduction programs (92%). Although most supported the government funding community-based services\/NGOs for delivering essential key population HIV services, 28.3% believed that existing laws and policies are in place for such funding, highlighting implementation gaps while knowledge and buy-in remain high.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study underscores the importance of identifying realistic timelines with key national stakeholders when designing and deciding timelines for transitioning from international external donor support to domestic budgeting for key population\u2013led HIV programming. It also highlights that although buy-in and understanding of key interventions is well known, there is a lack of sustained funding for these interventions that are essential to ending AIDS as a public health threat by 2030.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh24210","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T21:32:18Z","timestamp":1748295138000},"source":"Crossref","is-referenced-by-count":1,"title":["Financial sustainability of HIV services for key populations in four countries in Asia: a mixed-methods study"],"prefix":"10.1071","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7619-7243","authenticated-orcid":true,"given":"James","family":"Tapa","sequence":"first","affiliation":[{"name":"ASchool of Translational Medicine, Monash University, Melbourne, Vic, Australia. Email: James.Tapa@monash.edu"},{"name":"BMelbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Kusen","sequence":"additional","affiliation":[{"name":"CHealth Equity Matters, Bangkok, Thailand. Email: Matthew.Kusen@healthequitymatters.org.au"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicity","family":"Young","sequence":"additional","affiliation":[{"name":"DHealth Equity Matters, Sydney, NSW, Australia. Email: Felicity.Young@healthequitymatters.org.au, Mike.Merrigan@healthequitymatters.org.au"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Merrigan","sequence":"additional","affiliation":[{"name":"DHealth Equity Matters, Sydney, NSW, Australia. Email: Felicity.Young@healthequitymatters.org.au, Mike.Merrigan@healthequitymatters.org.au"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5784-7403","authenticated-orcid":true,"given":"Jason J.","family":"Ong","sequence":"additional","affiliation":[{"name":"ASchool of Translational Medicine, Monash University, Melbourne, Vic, Australia. Email: James.Tapa@monash.edu"},{"name":"BMelbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"volume-title":"UNAIDS 2020 data book","year":"2020","author":"UNAIDS","key":"2025111813190305400_R1"},{"key":"2025111813190305400_R2","unstructured":"UNAIDS\n          . From promises to action: scaling up efforts against human rights barriers including HIV related stigma and discrimination; 2021."},{"key":"2025111813190305400_R3","unstructured":"Avert\n          . HIV and AIDS in Asia & the Pacific regional overview 2020.. 2024. Available at https:\/\/www.avert.org\/printpdf\/node\/415"},{"key":"2025111813190305400_R4","unstructured":"Health Equity Matters\n          . Analyses for impact, efficiency, and sustainability of priority key population HIV services in Asia: Bhutan 2023. Burnet Institute; 2023."},{"key":"2025111813190305400_R5","unstructured":"AVERT\n          . HIV and AIDS in Asia Pacific regional overview 2020. Available at https:\/\/www.aidsdatahub.org\/"},{"key":"2025111813190305400_R6","unstructured":"National Centre for Communicable Diseases, Youth For Health, Burnet Institute, Matters HE\n          . Analyses for impact, efficiency, and sustainability of priority key population HIV services in Asia: Mongolia. Burnet Institute; 2023."},{"key":"2025111813190305400_R7","unstructured":"UNAIDS\n          . United Nations Programme on HIV\/AIDS; 2020."},{"issue":"5","key":"2025111813190305400_R8","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed8050258","article-title":"The state of the HIV epidemic in the Philippines: progress and challenges in 2023.","volume":"8","author":"Gangcuangco","year":"2023","journal-title":"Trop Med Infect Dis"},{"key":"2025111813190305400_R9","unstructured":"Health Equity Matters\n          . Analyses for impact, efficiency, and sustainability of priority key population HIV services in Asia: Sri Lanka. Melbourne: Burnet Institute; 2023."},{"key":"2025111813190305400_R10","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/2137164","article-title":"Redefining the mode of HIV transmission through analysis of risk attribution among the reported HIV cases from 1993 to 2021 in Bhutan.","volume":"2022","author":"Khandu","year":"2022","journal-title":"AIDS Res Treat"},{"key":"2025111813190305400_R11","unstructured":"UNAIDS, UNICEF, WHO. HIV and AIDS data hub for Asia-Pacific: evidence to action: Philippines.; 2022. Available at https:\/\/www.aidsdatahub.org\/country-profiles\/philippines"},{"key":"2025111813190305400_R12","unstructured":"Act 11166\n          . Philippines HIV and AIDS policy act; 2018."},{"key":"2025111813190305400_R13","unstructured":"Health Equity Matters\n          . SKPA-2 baseline assessment report \u2013 Philippines (2023); 2023."},{"key":"2025111813190305400_R14","unstructured":"UNAIDS, UNICEF, WHO. HIV and AIDS data hub for Asia-Pacific: evidence to action: Sri Lanka.; 2022. Available at https:\/\/www.aidsdatahub.org\/country-profiles\/sri-lanka"},{"key":"2025111813190305400_R15","unstructured":"Health Equity Matters\n          . Sustainability pulse check survey results October-November 2022.; 2022. Available at https:\/\/www.healthequitymatters.org.au\/resources\/sustainability-pulse-check-dashboard"},{"key":"2025111813190305400_R16","unstructured":"Health Equity Matters\n          . SKPA-2 baseline assessment report \u2013 Bhutan (2023); 2023."},{"key":"2025111813190305400_R17","unstructured":"Health Equity Matters\n          . SKPA-2 baseline assessment report \u2013 Mongolia (2023); 2023."},{"key":"2025111813190305400_R18","unstructured":"Health Equity Matters\n          . Overarching SKPA-2 baseline assessment report; 2023."},{"key":"2025111813190305400_R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2022.100097","article-title":"The epidemiological impact and cost-effectiveness of key population-led PrEP delivery to prevent HIV among men who have sex with men in Thailand: a modelling study.","volume":"7","author":"Versteegh","year":"2022","journal-title":"Lancet Reg Health Southeast Asia"},{"issue":"4","key":"2025111813190305400_R20","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1080\/15381501.2021.1986188","article-title":"Public contracting with civil society organizations for HIV\/AIDS service provisions: a key strategy to ending AIDS in Thailand.","volume":"20","author":"Pudpong","year":"2021","journal-title":"J HIV\/AIDS Soc Serv"},{"key":"2025111813190305400_R21","unstructured":"Health Equity Matters\n          . Sri Lanka SKPA-2 baseline assessment report; 2023."},{"key":"2025111813190305400_R22","unstructured":"Health Equity Matters\n          . Philippines SKPA-2 baseline assessment report; 2023."},{"key":"2025111813190305400_R23","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1071\/SH18065","article-title":"Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand.","volume":"15","author":"Phanuphak","year":"2018","journal-title":"Sex Health"},{"key":"2025111813190305400_R24","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25301","article-title":"Community-led HIV testing services including HIV self-testing and assisted partner notification services in Vietnam: lessons from a pilot study in a concentrated epidemic setting.","volume":"22","author":"Nguyen","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2025111813190305400_R25","unstructured":"UNAIDS\n          . Confronting discrimination overcoming HIV-related stigma in health care settings and beyond; 2017."},{"key":"2025111813190305400_R26","unstructured":"Joint United Nations Programme on HIV\/AIDS\n          . Confronting discrimination: overcoming HIV-related stigma in health care settings and beyond.. 2017. Available at https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/confronting-discrimination_en.pdf"},{"issue":"3S2","key":"2025111813190305400_R27","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.16.3.18734","article-title":"A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come?","volume":"16","author":"Stangl","year":"2013","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"2025111813190305400_R28","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.glohj.2021.10.001","article-title":"Transition of HIV prevention in three Southeast Asian countries: challenges and responses to the withdrawal of the Global Fund funding.","volume":"5","author":"Ren","year":"2021","journal-title":"Glob Health J"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH24210\/1361750\/sh24210.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH24210\/1361750\/sh24210.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T18:19:08Z","timestamp":1763489948000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/22\/3\/SH24210\/200632\/Financial-sustainability-of-HIV-services-for-key"}},"subtitle":[],"editor":[{"given":"Alissa","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,6,10]]}},"URL":"https:\/\/doi.org\/10.1071\/sh24210","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"type":"print","value":"1448-5028"},{"type":"electronic","value":"1449-8987"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"article-number":"SH24210"}}