Less than half of MSM in Malaysia know about PrEP

By Matteo Cassolato

Matteo Cassolato is the Alliance's senior advisor on HIV treatment.

The advent of pre-exposure prophylaxis (PrEP) has significantly expanded the HIV prevention options for people at high risk of acquiring HIV through sexual transmission. But although an increasing number of countries are making PrEP available, globally the number of people accessing it remains limited.

<p>Taking ARVs. Malaysia.&nbsp;</p>© Alliance

By early 2017, just 250,000 people were estimated to have started using PrEP (88% of whom live in the US), far short of the three million people UNAIDS has set the target of reaching by 2020.

Lack of access to PrEP…

In most parts of the world accessing PrEP is difficult.

Whilst more than 50 countries have granted regulatory approval for the use of antiretroviral medicines as prophylaxis (i.e. PrEP), only 15 of them have agreed to provide PrEP through their national health system. Along with the US, this includes Australia, Belgium, Brazil, France, Israel, Kenya, Luxembourg, Namibia, Norway, Portugal, Scotland, South Africa, Thailand and Zimbabwe.

In the rest of the world, PrEP can only be accessed through private means, either through a private practitioner without a regular prescription or via the Internet.

.. and lack of demand

In many contexts, the number of people at high risk of acquiring HIV who are aware of PrEP remains low.

A recent study conducted by the Alliance and the Malaysian AIDS Council assessing the willingness to use PrEP among men who have sex with men (MSM) in Malaysia found that only 44% of the 1,000 HIV negative participants were aware of PrEP’s existence. Even fewer (39%) said they would be willing to take PrEP.

The HIV prevalence among MSM in Malaysia is estimated at 8.9% (with a peak of 22% in the capital Kuala Lumpur), more than 20 times higher than the prevalence rate in the general population.

In addition, community surveys of MSM in Malaysia have reported high levels of risk behaviours such as condomless anal intercourse with casual partners and high levels of drug use before and during sex.

The ‘willingness to use’ study found that MSM who were aware of PrEP and who reported HIV risk-related behaviours were more likely than others to report a willingness to use PrEP were it to become available. This suggests PrEP would be acceptable by MSM at higher risk of acquiring HIV and should therefore be offered to them, something that the World Health Organization also recommends.

PrEP is an individual choice

No single HIV prevention method works for everybody, and in this way PrEP is no different.

People willing to take PrEP need to be able to assess their individual risk of acquiring HIV as well as being capable of taking PrEP correctly and consistently, as adherence is of paramount importance for PrEP to work.

Like all prevention methods, PrEP should always be provided in combination with other prevention options, such as condoms and lubricant, medical male circumcision, risk reduction counselling and stigma reduction programmes.

Taking a person-centred approach to HIV prevention, we must acknowledge that people are best placed to decide which prevention method is right for them, and empower them to make informed and positive choices about their health needs. This requires access to information about what’s available, and guidance to determine ‘what’s best for me’.

The research into the willingness to use PrEP among MSM in Malaysia consist of two studies, one quantitative and one qualitative. You can read the full research articles by clicking on the links below.

Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: Findings from an online survey

Willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia: findings from a qualitative study