Cambodia’s HIV model the region cannot ignore

Cambodia has become the first country in the Asia-Pacific to achieve the UNAIDS 95-95-95 targets – 95% of people living with HIV diagnosed, 95% of those on treatment, and 95% of those virally suppressed. This milestone (Opens in new window) is particularly notable for Cambodia having outpaced its wealthier neighbours in Southeast, where it ranks (Opens in new window) eighth out of the 11 members of the Association of Southeast Asia Nations for nominal GDP per capita.

The achievement also comes against a backdrop of sharply declining global HIV funding. International development assistance for HIV has fallen (Opens in new window) from a peak of US$8.6 billion in 2014 to US$7.5 billion in 2021. UNAIDS and the World Health Organisation warn these cuts threaten to reverse hard-won gains in the region, where new infections have plateaued or risen (Opens in new window), and nearly a third of people living with HIV still lack treatment access.

Cambodia’s success is telling precisely because it was built on constrained resources. When the United States launched (Opens in new window) the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, investing more than $100 billion in the global HIV/AIDS response, $1.2 billion was allocated (Opens in new window) to Cambodia between 2004 and 2022. The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002, has disbursed over $55.4 billion, with Cambodia receiving (Opens in new window) $414.8 million in HIV grants since 2003.

Despite this influx of resources, doubts persisted about Cambodia’s ability to effectively respond to HIV. In the early 2000s, Cambodia’s HIV prevalence was among the highest in Asia (Opens in new window), with limited infrastructure and human resources hampering progress. Yet Cambodia was one of only seven countries globally to achieve (Opens in new window) the 90-90-90 targets by 2017. It did so by adopting a differentiated, community-based model of care. Cambodia codified multi-month dispensing of antiretroviral therapy into national guidelines (Opens in new window), and built a community-based antiretroviral therapy delivery model and multi-month dispensing among people living with HIV. The community-based model showed markedly improved adherence, reduced depressive symptoms, and higher physical health-related quality of life. Such decentralised, community-based approaches are as effective (Opens in new window) as facility-based care in sustaining viral suppression, at lower per-patient costs.

A tangible lesson from Cambodia is in a system built to do more with less. By designing and iterating its HIV response around community needs rather than merely clinical opportuneness, Cambodia created a model that is both more affordable to run and better able to retain patients in care. In 2025, Cambodia saw just 958 new HIV infections, 84% of which were among key populations (Opens in new window), a testament to its community-embedded approach in reaching those most at risk.

The contrast with regional neighbours is stark. The Philippines has seen one of the fastest-growing epidemics in the Western Pacific, with new infections increasing by 237% from 2010 to 2021. Indonesia has struggled (Opens in new window) to retain patients across the care cascade, with only 24% of people living with HIV achieving viral suppression. Both countries have relied disproportionately on externally funded outreach to key populations where such services remain vulnerable as resources contract.

As donors retreat, Cambodia’s example offers a vital lesson. Resilience is built more by adaptation than abundance. Countries that have designed and iterated lean, community-led HIV services are best positioned to sustain progress in an era of scarcity. For those still dependent on externally-subsidised, facility-heavy models, the priority must be to fund the transition to more localised, more efficient care so that domestic financing becomes feasible.

Cambodia’s success is not without caveats. Stigma, discrimination, and mental health burdens among people living with HIV persist (Opens in new window). Its HIV response remains partially reliant on international aid, with domestic funding for HIV increasing but not yet sufficient (Opens in new window) for full sustainability. If external support is withdrawn too abruptly, even Cambodia’s gains could be jeopardised.

Then, the imperative is twofold. Donors need to prioritise preserving the community-based services that reach the most marginalised considering that these are often the first to be cut while possessing the greatest impact. Also, governments need to invest in a transition to leaner, carefully designed, locally embedded models of care, in which efficiency becomes the norm rather than a luxury.

Cambodia’s milestone is a testament to what is possible when constraint drives innovation. As the global HIV response enters an era of doing more with less, its success is a reminder that resilience can be found in will and right approaches, not in wealth.