Please refer to the attached file.
Executive summary
Primary HIV prevention programmes are vital for reducing new HIV infections and saving domestic resources which otherwise would be expended on treatment and support services if HIV transmission is not curbed.
About half of all new HIV infections worldwide in 2024 occurred among people from key populations and their sex partners, including gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs. In most countries, these key populations face stigma and discrimination in public health settings, which impair their access to and use of HIV and other health services.
UNAIDS and the World Health Organization therefore continue to advocate for differentiated service delivery models for people from key populations, including through community-led services. The 2021 Political Declaration on HIV and AIDS specified that community-led organizations should be delivering 80% of HIV prevention services for populations at high risk of HIV infection by 2025.
Despite many challenges, some countries have adopted HIV service delivery models for people from key populations that are entirely or partly financed domestically and that could be sustainable at scale. Civil society organizations are vital for these models, yet much of their work is unrecognized and underfunded.
This report provides an analysis and evaluation of the evidence to January 2025 for HIV prevention service delivery models for people from key populations, with a focus on models that are scalable and potentially sustainable. It includes real-world examples from different contexts that can guide efforts to enhance HIV prevention for people from key populations.
Three main funding modalities were identified:
■ Funding Model 1 applies to countries where primary HIV prevention programmes for people from key populations are funded primarily by external donors (e.g. Kenya, Nigeria and Zimbabwe).
■ Funding Model 2 entails arrangements where services are funded predominantly from domestic resources through a semi-autonomous agency, such as a health insurance company. It includes two subtypes, each using a different funding mechanism. Model 2(a) uses a tendering process for service providers such as civil society organizations (e.g. in the Republic of Moldova), or grants to provincial and municipal governments. In Model 2(b), services delivered by public primary healthcare entities and civil society organizations s are reimbursed (e.g. in the Philippines and Thailand).