Challenges

Differentiated Service Delivery (DSD)

• Uptake of multi-month dispensing has not been equal across different country contexts and in particular, South-East Asia has been slower to adopt policies for 6-month ART dispensing.
• Although differentiated service delivery models have advanced significantly across the region during the pandemic, many structural and operational issues which hinder implementation still need to be addressed.

HIV Prevention Services and PrEP

Lack of government commitment to ensuring universal access to HIV prevention services such as PrEP, poses a significant barrier for the procurement of such drugs. This not only presents a considerable cost for CBOs offering such services, but is also associated with higher individual out-of-pocket expenses in countries where services such as PrEP are only available through private clinics and services.

• Increasing conservatism in some countries in Asia and the Pacific, is hindering the rollout of HIV prevention efforts such as PrEP. Stigmatizing views and misinformation among health professionals and national policy makers prevails,
with some holding the belief that PrEP may lead to increasing condomless sex.
• Procurement at the organisation or national level, individual out-of-pocket expenses and long waiting times for enrolment present significant barriers for the uptake of PrEP.

Undetectable=Untransmittable (U=U)

• High levels of stigma and discrimination present many challenges for initiation onto treatment.
• Misinformation about U=U is still being communicated by healthcare providers throughout the region and awareness among people living with HIV and the general public remains quite low.
• National HIV treatment programs are often neglected, as governments direct their resources to tackling new HIV infections.

Community-led mechanisms and community-based monitoring

• Younger key population members and marginalized populations are often excluded from the planning and consultation processes of international funding agencies, due to barriers which prevent their engagement. These barriers include, but are not limited to:
• Language barriers
• Geographical location
• Lack of financial renumeration for participation (e.g. the costs associated with connecting to a virtual call from a location without Wi-Fi connectivity)
• Although international organizations tend to engage communities in initial planning phases of projects, implementation activities are usually led by international organizations with little involvement of community organizations, who actually have the power to help ensure the longevity and sustainability of projects.
• Considerable concern still remains over the accuracy of data collected through CLM.
• Disconnects between formal health systems and community response which often results in increasing marginalization of CLM.
• Lack of sustainable multi-year funding threatens the sustainability of routine CLM.

Community-led generation demand

• In an increasingly online world, the digital divide in Asia and the Pacific means that people without internet connectivity are often left behind from digital outreach activities.
• Community-led demand generation activities are more challenging to implement in more conservative societies where the messaging should be tailored to ensure it is culturally sensitive.