Proximity without sovereignty: community-led responses and the UNAIDS 30-80-60 targets in HIV governance in Kinshasa, DRC: a qualitative study

Abstract Background In the Democratic Republic of Congo, HIV remains concentrated among key populations, while current global strategies increasingly emphasize community-led responses. However, operational proximity to communities does not necessarily translate into meaningful influence over program priorities, budgets, or evaluation. This study examined how community participation in HIV programming is experienced in Kinshasa and assessed the gap between community-led rhetoric and decision-making reality. Methods We conducted a descriptive qualitative study with an evaluative orientation in Kinshasa between February and May 2025. Data was collected through 15 segmented focus group discussions involving 112 participants and 12 semi-structured individual interviews with community-based organization leaders and participants reporting violence, homelessness, or disruptions in care. Participants included men who have sex with men, sex workers, transgender people, people who inject drugs, peer educators, mediators, and community leaders. Data was analyzed thematically in NVivo 12 using a combined deductive-inductive approach. Interpretation was guided primarily by Arnstein's ladder of participation and community empowerment and secondarily contextualized using the Ottawa Charter and critical perspectives on decolonizing global health. Reporting followed COREQ. Results Six cross-cutting themes emerged: the vital usefulness of services despite persistent programmatic verticality; asymmetric co-creation; the centrality of socio-economic precarity; a hostile legal and social environment; criticism of accountability frameworks centered on service volume rather than lived experience; and the structural fragility of identity-based organizations. Across themes, participation was located mainly at the levels of consultation and placation rather than partnership or delegated power. Conclusions In this setting, community actors remain essential to service delivery but marginal to strategic decision-making. We conceptualize this configuration as "proximity without sovereignty." Credible progress towards community-led HIV responses requires earlier co-design, multi-year core funding for community organizations, stronger community-led monitoring, and legal and social protections that enable affected populations to shape - not only implement - the response.