KUALA LUMPUR, Dec 7 – HIV prevention drug PrEP far supersedes other prevention methods like condom use and abstinence in preventing HIV infection via sexual contact, HIV/AIDS groups said today.
The Malaysian AIDS Foundation (MAF), Malaysian AIDS Council (MAC), and the Malaysian Society for HIV Medicine (MASHM) pointed out that the pre-exposure prophylaxis (PrEP) oral medication is 99 per cent effective in reducing the chance of acquiring HIV via sexual contact and 74 per cent effective in reducing HIV transmission via injection drug use.
“Looking at the current trend of HIV transmission, scaling up PrEP is the best way forward that will bring us closer to our goal to end AIDS by 2030,” MAF, MAC, and MASHM said in a joint statement today.
“In the last 10 years, the scientific evidence for the effectiveness of PrEP in preventing HIV transmission has been shown in several large studies. More recently, a large-scale study in Australia involving 10,000 PrEP users showed that the new rate of HIV transmission has dropped by nearly 90 per cent — putting away any lingering doubt on the efficacy of PrEP as an HIV prevention tool.”
The HIV groups were responding to a statement issued by Prof Dr Rafidah Hanim Mokhtar, a professor in gender and cardiovascular physiology from Universiti Sains Islam Malaysia, and several family medicine specialists from other universities, that criticised the Ministry of Health’s (MOH) plans to provide PrEP for free in several selected public health clinics in states with high HIV prevalence from January 2023.
Dr Rafidah and her colleagues had advocated sexual abstinence instead, claiming that the PrEP programme will incur an “economically exorbitant” expense and encourage high-risk behaviour, particularly among men who have sex with men (MSM).
In an interview with CodeBlue, MAC president Assoc Prof Dr Raja Iskandar Raja Azwa compared PrEP to the oral contraceptive pill in terms of how their service delivery models should be accessible to people.
“We shouldn’t overmedicalise PrEP and I think, alongside the public sector, there should be other models of care or service delivery models like a community pharmacy-led PrEP service delivery model,” he said.
MAF chairwoman Prof Dr Adeeba Kamarulzaman noted that 96 per cent of new HIV cases globally in 2021 were caused by sexual transmission, concentrated largely among the MSM community.
“While we acknowledge the virtue of abstinence, we must also act based on scientific evidence in reducing the sexual transmission of HIV. Four decades of the HIV pandemic have shown that an insistence on abstinence alone is not enough to change the outcome of this global crisis,” Dr Adeeba, who is also former International AIDS Society president, said in the MAF-MAC-MASHM statement.
“Despite the weight of their vulnerability to HIV, the MSM community is also among the hardest to reach with HIV prevention services – largely due to overwhelming prejudice and a punitive legal system that criminalises their behaviour.
“In this time of crisis, taking a moral high ground against key populations runs counter to the basic tenet of human decency. There should be a concerted effort by each and every one of us to mitigate the HIV epidemic using the most powerful prevention tool in our arsenal.”
Dr Raja Iskandar said HIV prevention and care must be treated as a health-related issue, not a moralistic one.
“Every new HIV diagnosis is a failure of our public health to capitalise on existing HIV prevention tools at our disposal, including PrEP, to prevent that HIV infection,” he said.
MASHM president Dr Chow Ting Soo said counselling should be given on other methods of prevention of sexually transmitted diseases, on top of PrEP prescription.
“We should not regard this as a tool to promote sexual activities but rather as part of a prevention tool for HIV transmission.”
MAF, MAC, and MASHM also pointed out that the narrative against PrEP is “ironically identical” to the objection 10 years ago against MOH’s needle syringe exchange programme (NSEP) under a harm reduction initiative to prevent HIV among people who inject drugs.
“Rolled out amidst punitive drug laws that rank among the toughest in the world, the programme has successfully reversed the trajectory of the Malaysian AIDS epidemic,” they said.
“A study conducted by the Centre of Excellence for Research in AIDS (CERIA) revealed that more than 13,000 new HIV infections were averted in the first eight years of NSEP (2006-2013), while the estimated cost-savings in direct health care spending over the same period for HIV were about RM47 million.”
According to the UNAIDS’ “In Danger” 2022 report released last July, HIV infections have now increased since 2015 in 38 countries, including Malaysia and the Philippines, the only two Asean nations listed.
The report cited Malaysia and the Philippines as being among the countries with rising HIV epidemics among “key populations”, defined by UNAIDS as gay men and MSM, sex workers, transgender people, people who inject drugs, and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack adequate access to services.
“In contrast, many countries around the world, including high-burden countries, have successively shown a decline in new cases as a result of large-scale expansion of antiretroviral treatment and PrEP,” said MAF, MAC, and MASHM.
“We commend MOH for their planned PrEP implementation scale-up within the public sector as part of an additional evidence-based HIV prevention strategy to mitigate sexual transmission of HIV.
“We urge all stakeholders to follow the science and the precedent that was set by NSEP, making sure that evidence-based decision-making prevails in the face of an impending public health crisis.”