An innovative HIV prevention tool, which has shown 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 programmes in Asia. Representatives from national AIDS programmes, 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 and FHI360.
"We know that insisting on using condoms alone does not work for HIV prevention and PrEP can be an option for some MSM, but this needs to be integrated into the current prevention package,” said Midnight Poonkasetwattana, APCOM’s Executive Director. “APCOM's role is to ensure that our community know the correct information on PrEP and can advocate for its inclusion at the national level."
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.”