Supporting PrEP As A Preventive Medicine For All Malaysians – DOC2US

PrEP is registered and legal in Malaysia and is part of the National Strategic Plan to end AIDS by 2030.

If you are an avid follower of the news, you must have heard of the inhibition of Pre-Exposure Prophylaxis (PrEP) to homosexual couples announced by the mufti a few weeks ago, as it is thought to be encouraging “deviant” lifestyles.

This has raised several debates across the internet, with passionate and dedicated allied health care professionals who advised against not providing PrEP pills for homosexuals, saying that the medication is essential to eradicate and minimise the rising rate of HIV infections in the country.

To understand what PrEP is, and how it can prevent one from getting HIV, keep reading.

What Is PrEP?

Pre-Exposure Prophylaxis, also known as PrEP for short, is a type of prevention treatment designed for people who do not have HIV, but are at risk of getting it such as those who:

  • Have a sexual partner(s) who are HIV positive. 
  • Received a sexually transmitted infection (STI) diagnosis in the last six months,
  • Do not consistently use condoms during sexual intercourse,
  • Use injected recreational drugs and have a habit of sharing needles with others. 
  • Any of the above who are considering getting pregnant. 

In Malaysia, the oral PrEP — Truvada (emtricitabine/ tenofovir disoproxil fumarate) is commonly used, and can be obtained at the selected local klinik kesihatan or hospitals upon thorough health screening and prescription from your physician.

The oral PrEP treatment should be taken once a day either before or after meals, and they are only available with a prescription. If one takes PrEP and they are exposed to HIV via unsafe sexual encounters or needle use, PrEP can keep the virus from establishing itself inside his/her body, as long as treatment is initiated before possible exposure to HIV.

How Effective Is PrEP?

According to the United States’ Centers for Disease Control and Prevention (CDC), PrEP minimises the risk of being infected by HIV from sex by approximately 99 per cent, and has 74 per cent effectiveness among intravenous drug users, provided users are taking them regularly as instructed by their physicians.

Is PrEP Safe For Pregnant Or Breastfeeding Mothers?

Yes. If you or someone you know is pregnant or is breastfeeding and is at high risk of getting HIV, it is highly encouraged you consult your physician about PrEP if you are not already on it. It may be a safe option to help protect you and your baby from getting HIV.

It is also safe for those who are on contraceptives either via pill, patch, or ring to be on PrEP, as there are no known interactions between the two.

Do I Need To Take PrEP For The Rest Of My Life, Or Only Take It When I’m At Risk Of Being Infected By HIV?

For optimum efficacy, it is recommended that you take PrEP once a day, ideally at the same time every day. Good news is, with proper medical guidance and routine follow-up, PrEP does not have to be lifelong as long as you are no longer at risk for HIV infection.

It is recommended that once you’ve started taking PrEP, you should stay on it for at least seven days after you were last exposed to HIV to ensure complete protection.

This is because it generally takes a minimum of seven to 21 days of daily use for it to achieve its peak therapeutic effect. If you think that you are no longer at risk of getting HIV (change of lifestyle), kindly talk to your doctor before stopping treatment altogether.

Alternatively, there is also an option where you take PrEP only when there is a high risk for HIV (not daily dose), known as On-Demand PrEP (PrEP 2-1-1). This means taking two pills two to 24 hours before sexual intercourse, one pill after 24 hours of the first dose, followed by one final dose 24 hours after the second dose. This method is only effective for gay men and other men who have sex with men.

Do I Still Need To Use Additional Barriers If I’m Already On PrEP?

Yes. PrEP can only stop you from getting HIV, but it doesn’t necessarily protect you from other sexually transmitted diseases (STDs) such as chlamydia, syphilis, gonorrhea, etc, neither does it protect you from pregnancy. Hence, to be safe, it is always recommended that you practice safe sex measures in order to be sexually healthy and free.

Side Effects

PrEP is generally safe. Studies have also demonstrated safe use in high-risk patients who are HIV-negative. Nonetheless, just like any other medicines, PrEP may bring some side effects to certain patients such as nausea, vomiting, fatigue, and dizziness. For most, these side effects eventually go away after a while. 

In some patients, Truvada is also seen increasing creatinine and transaminase levels in the body, which would subsequently result in kidney problems. Another possible side effect from PrEP is a reduced bone mineral density.

However, this is reversible, as studies have found bone density to return to normal range once Truvada was stopped. It is therefore advised that those who are on PrEP to visit their doctors every three months for HIV testing and follow-up care to ensure their kidneys and bones remain healthy and strong.

Supporting PrEP As A Preventive Medicine For All Malaysians

HIV, while not as common as other infections, can be serious, as it will severely compromise our immune system and make us vulnerable to numerous opportunistic infections.

Thus, proper education and awareness along with cooperativeness from all stakeholders is of utmost importance in minimising the risk of HIV infections in Malaysia.

As a strong advocate of the four health care ethics (Autonomy, Non-Maleficence, Beneficence, and Justice), the Malaysian Medical Association (MMA) has insisted on the importance of making PrEP accessible to everyone regardless of their sexual orientation or their lifestyle in order to fight against HIV as a country.

PrEP is registered and legal in Malaysia and is part of the National Strategic Plan to end AIDS by 2030. Different religions may have varying views on the use of PrEP, however, the reality is that HIV requires a non-religious intervention and prevention programme.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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