An ecological analysis of legal policy environments and reported pre exposure prophylaxis availability for key populations in Asia Pacific countries
4 affiliations
- 1Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
- 2Kartavya Disha Global Foundation
- 3Department of Public Health Dentistry, Goa Dental College
- 4Timori Kyomu Research and Innovation
Abstract
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.
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BibTeX
@article{mali2026ecological,
title = {{An ecological analysis of legal policy environments and reported pre exposure prophylaxis availability for key populations in Asia Pacific countries}},
author = {Marcelo Amaral Mali and Abhishek Royal and Vaibhav Kumar and Atrey J. Pai Khot and Nelsensius Klau Fauk},
journal = {Discover Social Science and Health},
year = {2026},
month = jul,
doi = {10.1007/s44155-026-00459-7},
url = {https://doi.org/10.1007/s44155-026-00459-7},
note = {CC BY},
}
RIS
TY - JOUR
TI - An ecological analysis of legal policy environments and reported pre exposure prophylaxis availability for key populations in Asia Pacific countries
AU - Marcelo Amaral Mali
AU - Abhishek Royal
AU - Vaibhav Kumar
AU - Atrey J. Pai Khot
AU - Nelsensius Klau Fauk
PY - 2026
DA - 2026/07/01
JO - Discover Social Science and Health
DO - 10.1007/s44155-026-00459-7
UR - https://doi.org/10.1007/s44155-026-00459-7
AB - 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.
SN - 2731-0469
ER -