Advancing health and human rights to end AIDS in Thailand A multisectoral response to exclusion, vulnerability, and volatility

What will it take to end AIDS by 2030 in Thailand? Despite progress, Thailand risks missing the target as HIV vulnerability is reshaped by social shifts, mental health, and online networking. In this thesis, the Equitable HIV Service Delivery framework was developed to examine how service uptake among key populations (KPs) is hindered by restrictive laws, human rights violations, social exclusion, and financing constraints.
Punitive laws continue to criminalize KPs — specifically sex workers (SWs), including male, female, and transgender women, as well as people who use drugs. These KPs face stigma, discrimination, and barriers to essential HIV services, including pre-exposure prophylaxis (PrEP). Male SWs report extreme vulnerability, including the highest rates of sexual violence and unprotected group sex, while cisgender female SWs have become increasingly invisible in the modern biomedical landscape, exhibiting near-zero national PrEP uptake of 1.3% and a high rate of never testing. Intersectional vulnerabilities further impact service access and uptake, particularly among gender and sexuality diverse adolescents whose special needs remain omitted from national mental health and HIV policy. New risks are emerging among SWs including group sex, gender-based violence (GBV), chemsex, and a shift to online client recruitment. Young female SWs are underserved.
Ending AIDS requires shifting from a biomedical model toward a multisectoral rights-based framework that further advances Key Population-Led Health Services (KPLHS). Sustainable success will depend on expanding new PrEP options, scaling domestic social contracting, integrating mental health and GBV care, decriminalizing sex work, and fostering robust government and civil society partnerships in service delivery.