PrEP access in Southeast Asia: what CHASE Phase 2 found
Country by country, the gap between a PrEP policy existing and a person being able to start it is where most of the work still sits.
By Andrew Spieldenner
Every country the CHASE programme works in now has a PrEP policy of some kind. That is a genuine shift from where the region was five years ago, and it is also where the easy part ended.
A policy is not a prescription
The second phase of the programme set out to document what happens between a national guideline being published and a person walking out of a clinic with PrEP. The distance turns out to be measured in things no guideline mentions: whether a clinic requires a national ID that many of the people who need it do not hold, whether the nearest dispensing site is reachable and back in a working day, whether the staff at the desk have been trained to expect you.
The three consistent blockers
- Documentation. Eligibility tied to residency papers excludes migrants and displaced people, who are frequently at the highest risk.
- Geography. Provision concentrated in capital cities turns a daily medication into a monthly journey.
- Cost recovery. Nominally free programmes that recover consultation or laboratory fees reintroduce the barrier they removed.
What community-led delivery changes
Where community organisations were authorised to dispense — not merely to refer — continuation rates held up. The reason is unglamorous: a person is more likely to come back to a service that has never made them explain themselves. Referral-only models keep the clinical relationship in a building that many people have a reason to avoid.
Continuation is the real measure. Starting PrEP is a clinic event; staying on it is a question of whether the service was built around your life.
Where the advocacy goes next
Phase 3 concentrates on the two changes with the most leverage: task-shifting authority to community organisations, so dispensing sits where people already go, and decoupling eligibility from documentation. Both are decisions national programmes can make without waiting for new funding, which is precisely why they are worth pressing.
Our regional partners are taking that case into the country coordinating mechanisms, with the evidence base from this phase behind it. You can read more about how this fits our wider work on what we do.
