Demedicalisation of HIV interventions to end HIV in the Asia–Pacific

Rena Janamnuaysook; Kimberly Elizabeth Green; Pich Seekaew; Bao Ngoc Vu; Huu Van Ngo; Hong Anh Doan; Supabhorn Pengnonyang; Ravipa Vannakit; Praphan Phanuphak; Nittaya Phanuphak; Reshmie Ashmanie Ramautarsing

doi:10.1071/SH20172

REVIEW (Open Access)

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Demedicalisation of HIV interventions to end HIV in the Asia–Pacific

Rena Janamnuaysook

^A ^B ^F , Kimberly Elizabeth Green ^C , Pich Seekaew ^A ^D , Bao Ngoc Vu ^C , Huu Van Ngo ^C , Hong Anh Doan ^C , Supabhorn Pengnonyang ^A , Ravipa Vannakit ^E , Praphan Phanuphak ^A , Nittaya Phanuphak

^A ^B and Reshmie Ashmanie Ramautarsing

^A

+ Author Affiliations

- Author Affiliations

^A Institute of HIV Research and Innovation, Bangkok, Thailand.

^B Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand.

^C PATH, Hanoi, Vietnam.

^D Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.

^E Independent consultant. Email: vannakit.r@gmail.com

^F Corresponding author. Email: rena.j@ihri.org

Sexual Health 18(1) 13-20 https://doi.org/10.1071/SH20172
Submitted: 15 September 2020 Accepted: 30 November 2020 Published: 26 February 2021

Journal Compilation © CSIRO 2021 Open Access CC BY-NC

Abstract

Despite the challenges to the HIV response in the Asia–Pacific, a demedicalisation of HIV intervention has been demonstrated to be an important strategy to maximise the uptake of HIV prevention tools among key populations in this region. Demedicalisation of HIV interventions translates medical discourse and shifts the paradigm from a disease-focused to a people-centred approach. It also recognises real-life experiences of key populations in the HIV response by empowering them to voice their needs and be at the forefront of the epidemic control. We further categorise a demedicalisation approach into three frameworks: (1) the demystification of clinical or medical concerns; (2) the destigmatisation of people living with HIV; and (3) the decentralisation of healthcare services. This article reviewed the demedicalisation framework by looking at the HIV intervention examples from countries in the Asia–Pacific, which included: (1) a study on drug–drug interaction between pre-exposure prophylaxis and feminising hormone treatment for transgender women; (2) the roles of key population-led health services; and (3) certification of key population lay providers.

Keywords: Asia, Asia–Pacific region, demedicalisation, decentralisation, demystification, destigmatisation, epidemic, HIV/AIDS, HIV prevention, key populations, vulnerable populations.

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