Last month, the Selangor mufti department opposed the dispensing of Pre-Exposure Prophylaxis (PrEP) to those who “practise a homosexual lifestyle”, saying it would be a form of complicity in sin. A Penang mufti then came out in support of the department and, just yesterday, a PAS MP said the health ministry should reevaluate the use of the drug.

These developments have led to debate across the internet, with allied passionate and dedicated healthcare professionals – including the Malaysian Medical Association (MMA) and the Pharmacists Society – advising against the inhibition of PrEP access for homosexuals, saying the medication is essential to eradicate and minimise the rising rate of HIV infections in the country.

So what, exactly, is PrEP, and why is it so controversial?

Pre-Exposure Prophylaxis is a type of prevention treatment designed for people who do not have HIV but are at risk of being infected, including:

• those who have sexual partner(s) who are HIV positive;
• those who received a sexually transmitted infection (STI) diagnosis in the last six months;
• those who do not consistently use condom during sexual intercourse;
• those who use injected recreational drugs and have the habit of sharing needles with others;
• any of the above who are considering getting pregnant.

In Malaysia, Truvada, the oral version of PrEP, is commonly used and can be obtained at selected government clinics or hospitals upon thorough health screening and prescription from your physician.

If one takes PrEP and is exposed to HIV via unsafe sexual encounters or needle use, it can keep the virus from establishing itself inside one’s body, as long as treatment is initiated before exposure.

How effective is it?

According to the United States Centers for Disease Control and Prevention, PrEP minimises the risk of being infected by HIV through sex by approximately 99%.

Among injected-drug users, there is a 74% effectiveness rate, as long as PrEP is taken regularly as instructed by health professionals.

Is it safe for pregnant or breastfeeding women?

Yes. If you are pregnant or breastfeeding and are at high risk of getting HIV, PrEP may be a safe option to help protect you and your baby.

It is also safe for those who are on contraceptives (pill, patch or ring) as there are no known interactions between the two.

How often do you take it?

This treatment is indicated to be taken once a day either before or after meals.

For optimum efficacy, it is recommended that PrEP be taken once a day, ideally at the same time. With proper medical guidance and routine follow-up, PrEP does not have to be taken for life, as long as you are not at risk of HIV infection.

Once you start on 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 seven to 21 days of daily use to achieve peak therapeutic effect.

There is also an option where you take PrEP only when there is a high risk of HIV, as opposed to a daily dose. This is known as On-Demand PrEP (PrEP 2-1-1), which requires taking two pills two to 24 hours before sexual intercourse; one pill after 24 hours of the first dose; followed by one final dose another 24 hours later.

This method is only effective for men who have sex with other men.

Do you need additional barriers if you’re already on PrEP?

Yes. PrEP can only stop you from getting HIV but it doesn’t necessarily protect you from other STIs such as chlamydia, syphilis, or gonorrhoea; neither does it protect you from pregnancy.

It is always recommended for you to practise safe sex.

Are there any side effects?

Studies have demonstrated safe use in high-risk patients who are HIV-negative. Nonetheless, just like any other medicines, PrEP may lead to certain side effects in some users, including nausea, vomiting, fatigue, and dizziness. These usually go away after a while.

Truvada has also been seen to increase creatinine and transaminase levels in some patients, which could result in kidney problems.

Another possible side effect is reduced bone-mineral density. Fortunately, this is reversible as studies have found that bone density returns to normal range once Truvada is stopped.

Those on PrEP should 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 preventative medicine

HIV can severely compromise your immune system and make you vulnerable to numerous infections. As such, proper education and awareness are of utmost importance in minimising the risk of HIV infections in Malaysia.

As an advocate of the four healthcare ethics as outlined above, the MMA has called for PrEP to be made accessible to everyone regardless of sexual orientation or lifestyle, in order to collectively fight against HIV in the country.

PrEP is registered and legal in Malaysia, and is part of the National Strategic Plan to end AIDS by 2030. While various parties will have differing views on its use, the reality is that eradicating HIV requires a non-political and non-religious intervention and prevention strategy.

This article was written by DOC2US, a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.