Financial sustainability of HIV services for key populations in four countries in Asia: a mixed-methods study

James Tapa; Matthew Kusen; Felicity Young; Mike Merrigan; Jason J. Ong

doi:10.1071/SH24210

RESEARCH ARTICLE (Open Access)

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Financial sustainability of HIV services for key populations in four countries in Asia: a mixed-methods study

James Tapa

^A ^B ^# , Matthew Kusen ^C ^# , Felicity Young ^D , Mike Merrigan ^D and Jason J. Ong

^A ^B ^*

+ Author Affiliations

- Author Affiliations

^A School of Translational Medicine, Monash University, Melbourne, Vic, Australia. Email: James.Tapa@monash.edu

^B Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

^C Health Equity Matters, Bangkok, Thailand. Email: Matthew.Kusen@healthequitymatters.org.au

^D Health Equity Matters, Sydney, NSW, Australia. Email: Felicity.Young@healthequitymatters.org.au, Mike.Merrigan@healthequitymatters.org.au

^* Correspondence to: Jason.ong@monash.edu

^# These authors contributed equally to this paper

Handling Editor: Alissa Davis

Sexual Health 22, SH24210 https://doi.org/10.1071/SH24210

Submitted: 7 November 2024 Accepted: 12 April 2025 Published: 27 May 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Key populations and their sexual partners account for 98% of new HIV infections in the Asia–Pacific 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–led HIV programming in these countries through diverse stakeholder perspectives, including limitations of procurement processes, budget allocation systems and political will.

Methods

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–led, non-government (NGO), and multilateral), with 30 stakeholders per country identified. The same respondents were targeted for quantitative and qualitative data collection.

Results

Key informant interviews included 60 staff from government organizations, 42 from key population–led organizations, 31 from NGOs, and 12 from multilateral organizations. For the survey (n = 60), responses were from key population–led (35%), government (32%), NGOs (23%) and multilateral organizations (10%). Regarding the timeline for increased domestic financing for key population–led HIV services, 45% of participants thought it would take 5–10 years to expand them without reliance on external donors, 25% thought more than 10 years and 5% thought between 0 and 3 years. Almost all government and key population–led 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.

Conclusions

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–led 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.

Keywords: Asia-Pacific, Bhutan, financial sustainability, HIV, key populations, Mongolia, Philippines, Sri Lanka.

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