26th International AIDS Conference 2026 in Rio de Janeiro
Contribution by Patricia Gründler

A workshop at AIDS 2026 addressed one of the key challenges facing HIV work today: how can services for key populations be secured in the long term when available funding is declining and services are increasingly being integrated into primary care?

The discussion took as its starting point the reality facing many countries: cuts to funding – primarily international, but also domestic – are leading to community-based services being scaled back or discontinued altogether. The integration of HIV and STI prevention into primary care is therefore seen in many places as a necessary step. The crucial question is often not whether, but how this should be done. So how can services for key populations be integrated into primary care without compromising effectiveness?

The WHO guidelines stipulate that services for key populations must be: available, accessible, acceptable and of high quality.

It was emphasised on several occasions that prevention must focus on areas where gaps in care and infections are concentrated. In countries with a concentrated epidemic – such as Switzerland – approaches that target the entire population are not sufficient on their own. In order to reach people at increased risk, services tailored to specific target groups are still required.

A central theme of the workshop was trust. Particularly among key populations, trust often determines whether people actually make use of health services. Whilst services may technically be available, they may remain effectively inaccessible to those affected due to stigmatisation, discrimination or negative experiences. Community-based organisations therefore play a crucial role because they have established relationships and credibility within the communities.

Protecting services for key populations

At the same time, it was pointed out that services for key populations are often inadequately institutionally safeguarded worldwide. They are therefore frequently among the first areas to be affected by cost-cutting measures. The challenge lies in embedding HIV and STI services more firmly within primary care without losing the specific strengths of community-led approaches.

Successful integration does not create a system in which there is a single point of entry for every individual. Instead, an ecosystem comprising various stakeholders and services is required. Primary care, specialised services and community-based organisations fulfil different, complementary functions. Sustainability is achieved not by replacing one stakeholder with another, but through effective collaboration.

Five key recommendations for successful integration into primary care were formulated at the workshop:

• Embed community-led services as an essential element of the institutional healthcare system.
• Integrate funding mechanisms and referral systems without shifting all services to healthcare institutions.
• Establish national funding and social contracting mechanisms for community organisations.
• Continue to ensure a range of tailored services, community monitoring and target-group-specific data.
• Measure the success of integration processes in terms of access, trust, equity and health outcomes, and not solely on the basis of the proportion of nationally funded services.

Conclusion: Integration can be a sensible and necessary way of maintaining services despite scarce resources. However, it must not result in the specific needs of key populations being overlooked. Ideally, integration can even enable the needs of key populations to be addressed more effectively. For integration to work, therefore, the experience, trust and expertise of community-based organisations must be preserved as an indispensable part of the healthcare system.

Further reading: Consolidated guidelines on HIV, viral hepatitis and STIs for key populations – 2022