Suman Nepal / Pahichan – A new HIV prevention tool shows to be effective at reducing the transmission of HIV in gay men and others at higher risk is to be introduced in parts of Asia.

While, oral pre-exposure prophylaxis or PrEP is starting to transform HIV prevention in the United States, it has yet to be integrated into programs in Asia. Representatives from national AIDS programs, health service providers and community groups from eighteen countries in Asia are exploring how to roll-out PrEP at a meeting taking place from 23-25 September in Bangkok, Thailand.

PrEP is the use of antiretroviral medication in the form of a daily pill to prevent people from acquiring HIV. It has shown up to 90% effectiveness in preventing the transmission of HIV in people at substantial risk, including gay men and other men who have sex with men (MSM), HIV-negative people whose partners are living with HIV, transgender women and people who inject drugs.The three day consultation PrEPARING Asia is led by the Asia Pacific Coalition on Male Sexual Health (APCOM) with support from the Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization, UNICEF, USAID, FHI360, UNDP and the Multi-Country South Asia Global Fund HIV Programme.

Asia is experiencing a severe AIDS epidemic among MSM. In six countries HIV prevalence is greater than 5% and surveys indicate that in some large cities prevalence ranges from 15% to 30% among MSM. Consistent condom use remains low. In most major Asian cities less than half of MSM are using condoms consistently, which is far too low to have an impact on stopping the AIDS epidemic.“The numbers say it all. We can not stop new HIV infections in gay men and other men who have sex with men if we stick to business as usual,” said Steve Kraus, Director of UNAIDS Regional Support Team for Asia and the Pacific. “PrEP answers an unmet need and expands the prevention options for people at substantial risk of HIV. We need to scale up PrEP as an additional effective HIV prevention intervention.”

PrEP is currently the only available prevention option that HIV-negative people can use discretely and not at the time of sex. However, it does not prevent other sexually transmitted infections and is not a contraceptive, so its provision is best integrated with other sexual and reproductive health services, including condoms.

So far only the United States has approved the use of PrEP for HIV prevention. Other parts of the world have much less information. In Asia, Thailand is playing a leading role in increasing awareness and demand, with the Thai Red Cross AIDS Research Center offering PrEP to a small number of MSM as part of a combined pilot HIV prevention program.The rollout of PrEP faces challenges as users need to have regular medical check-ups and evaluation, including HIV tests and effectiveness is highly dependent on adherence.While acknowledging the challenges, leading epidemiologist and President of the International AIDS Society Chris Beyrer said: “The time to act is now. The evidence is overwhelming. PrEP works.”

What is PrEP ?

Pre Exposure Prophylaxis (PrEP) is an HIV prevention approach where HIV-negative individuals use HIV medication to significantly reduce their risk of becoming infected if they are exposed to the virus. A common brand of medication used for PrEP is called Truvada. Its cheaper/generic version are available in some countries. When you read or hear “PrEP pills”, it’s the Truvada pills that they’re talking about. Truvada prevents HIV infection in our body by blocking the enzyme that’s used by the virus to make more copies of itself.

How effective is PrEP?

According to the PROUD study, in which 500 men who have sex with men (MSM) were enrolled, PrEP reduced the number of infections up to 96%.  According to another research, iPrEx study, in which 2499 MSM and transgender women were signed up, people who take PrEP pills daily acquire up to 99% level of protection.

Who does recommend PrEP?

With 2.7 million people becoming infected annually worldwide,World Health Organization (WHO) and United States Centers for Disease Control and Prevention (CDC) recommend PrEP as an important intervention to complement existing HIV prevention tools among HIV-negative MSM, particularly to those who are in relationship with HIV-positive person or at substantial risk of HIV such as those who don’t regularly use condom during intercourse.

Do we need new prevention tools?

Condoms are a great protection against HIV, but there are many cases when many of us are forgetting or choosing not to use condoms. Reasons like getting caught up in the moment, feeling that condoms block emotional intimacy, having difficulty to keep an erection, or too drunk to use condoms are often heard.

Also, external factors like homophobia, discrimination based on sexual orientation and gender expression, racism, poverty and homelessness, may encourage risk behavior among marginalised MSM while also amplify substantial health discrepancies across various socio-economic groups among them.

A scientific estimation indicates that, without a more effective intervention, MSM could make up half or more of all new HIV infections in Asia by 2020. New prevention tools are urgently needed to change the game. Now that PrEP has been shown to be effective in clinical trials, the next step is to ensure how you and other MSM around the world have an access to PrEP.

Should I just take PrEP before having sex?

No, you shouldn’t. It takes at least four to seven days of dosage adherence for you to reach maximum protection from HIV. Here’s a breakdown according to iPrex study: If you take 7 pills per week, your estimated level of protection is 99%. If you take 4 pills per week, your estimated level of protection is 96%. And REMEMBER to continue taking PrEP at least 28 days after a possible exposure.

This whole thing is new. And what about the side effects? I will wait a little bit more to be on board. 

PrEP is a prophylactic approach and the medical world has been doing this since a long time ago. Anti-malaria pills, for example, has been around for decades to help travelers avoiding malaria infection in tropical countries. These travelers are expected to start taking antimalarial drugs few weeks before and during their journey.

However, just like how anti-malaria pills are giving you protection against malaria vector mosquitos but not the dengue fever mosquitos and other tropical parasites, PrEP won’t protect you from other sexual transmission infections such as gonorrhea and syphilis.

For the first few weeks of starting PrEP, some people complain about nausea, vomiting, fatigue, and dizziness, with these minor symptoms eventually resolving themselves over time.