Abstract
INTRODUCTION: "Person-centred" and "people-centred" HIV prevention programmes both seek to scale up access to HIV prevention services. A "person-centred" approach presents a vision of a client with agency in decision-making, engaged and empowered, working with providers in a process that is not disease-centric but focused on addressing, holistically, a client's needs. A "people-centred" approach recognizes the broader role of family and community, as well as the influence of the political and legal environment as barriers or facilitators to HIV services. In both cases, human rights are a critical determinant of positive or negative outcomes. DISCUSSION: In 2017, the Global Fund's Breaking Down Barriers initiative funded baseline assessments in 20 countries examining key human rights barriers to HIV services. Subsequent evaluations in 2019-2021 and 2022-2024 focused on the scale-up of community-led human rights interventions and the impact of these programmes on access to HIV prevention and care. Results from the latest assessment describe a range of strategies and impact across diverse countries, settings and populations. For example, in Indonesia, transgender-led organizations catalysed a national drive to allow transgender persons to receive gender-matched identity cards, allowing thousands of individuals to access HIV prevention and treatment and broader social benefits. In Mozambique, peer-led paralegals and community advocates promoted legal literacy and assisted clients with claims of human rights violations, preventing access to HIV services. In Jamaica, lesbian, gay, bisexual and transgender led organizations sponsored trainings that advanced community activism for HIV prevention, education and advocacy. Despite facing stigma and challenging legal environments, in each case, human rights-based programmes removed structural and legal barriers to HIV prevention services, strengthening accountability and increasing uptake and retention in HIV services, especially among marginalized and criminalized populations. CONCLUSIONS: Community mobilization led by key populations is a long-term undertaking that requires partnership and support from a wide range of stakeholders to ensure sustainability. A growing body of evidence across a range of diverse countries and settings demonstrates the impact of rights-based and people-centred programmes on access to, and retention in, HIV prevention and treatment.