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Objective <p>This study aims to assess how national laws and policies affecting key populations relate to Pre-Exposure Prophylaxis (PrEP) availability across 40 Asia‑Pacific countries. We use a cross‑national ecological design and secondary UNAIDS data to quantify legal vulnerability and its association with PrEP programme presence and scale.</p> Methods <p>A quantitative ecological analysis was conducted using secondary data submitted by 40 Asia–Pacific countries to UNAIDS. Country-level indicators related to laws, legal protection rights, and participation of KPs in the development of HIV-related policies were extracted. Twenty-two indicators across four key populations—People Who inject Drugs (PWID: 7), female sex workers (FSWs: 4), transgender people (transgender people: 6), and men who have sex with men (MSM: 5)—were used to generate cumulative legal–policy scores for each country. Countries were categorised by reported PrEP availability (available, not available, or not reported). One-way analysis of variance (ANOVA) assessed differences in mean scores across groups, with Bonferroni post-hoc tests.</p> Results <p>Among the 40 countries, 12 reported PrEP availability, 14 reported non-availability, and 14 did not report PrEP status. Mean cumulative legal–policy scores (maximum = 22) were 8.92, 10.07, and 1.71, respectively. ANOVA showed statistically significant differences across groups, driven primarily by countries with non-reported PrEP data.</p> Conclusions <p>This ecological analysis suggests that non-reporting of PrEP and legal–policy indicators emerged as a structurally suggestive signal, pointing to possible links with unfavourable legal contexts and limited prevention readiness rather than neutral data gaps.</p>

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An ecological analysis of legal policy environments and reported pre exposure prophylaxis availability for key populations in Asia Pacific countries

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月25日

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  • Marcelo Amaral Mali,
  • Abhishek Royal,
  • Vaibhav Kumar,
  • Atrey J. Pai Khot,
  • Nelsensius Klau Fauk

摘要

Objective

This study aims to assess how national laws and policies affecting key populations relate to Pre-Exposure Prophylaxis (PrEP) availability across 40 Asia‑Pacific countries. We use a cross‑national ecological design and secondary UNAIDS data to quantify legal vulnerability and its association with PrEP programme presence and scale.

Methods

A quantitative ecological analysis was conducted using secondary data submitted by 40 Asia–Pacific countries to UNAIDS. Country-level indicators related to laws, legal protection rights, and participation of KPs in the development of HIV-related policies were extracted. Twenty-two indicators across four key populations—People Who inject Drugs (PWID: 7), female sex workers (FSWs: 4), transgender people (transgender people: 6), and men who have sex with men (MSM: 5)—were used to generate cumulative legal–policy scores for each country. Countries were categorised by reported PrEP availability (available, not available, or not reported). One-way analysis of variance (ANOVA) assessed differences in mean scores across groups, with Bonferroni post-hoc tests.

Results

Among the 40 countries, 12 reported PrEP availability, 14 reported non-availability, and 14 did not report PrEP status. Mean cumulative legal–policy scores (maximum = 22) were 8.92, 10.07, and 1.71, respectively. ANOVA showed statistically significant differences across groups, driven primarily by countries with non-reported PrEP data.

Conclusions

This ecological analysis suggests that non-reporting of PrEP and legal–policy indicators emerged as a structurally suggestive signal, pointing to possible links with unfavourable legal contexts and limited prevention readiness rather than neutral data gaps.