With an exciting gay scene offering plenty of gay bars, clubs, saunas, and massage spots, Thailand has for years been a hot destination for gay men across Asia. However, many are now heading to this Southeast Asian country for an entirely new reason - to stock up on cheap drugs that prevent HIV.
Pre-exposure prophylaxis, known as PrEP, is a prevention program that involves taking a pill, which if taken daily can reduce the risk of HIV infection through sexual intercourse by more than 90 per cent. The WHO recommends PrEP as an additional prevention tool to help fight the spread of HIV among people in high-risk groups, particularly gay men and other men who have sex with men. However, the availability and accessibility of PrEP for men who have sex with men varies widely across Asia.
In many countries, Truvada or its generic equivalent (the medication used for PrEP) is not available because it is either not approved for use ast all or is only approved for use as treatment and not for prevention (meaning doctors are not allowed to prescribe it to patients unless they already test positive for HIV).
Chan Wang Tu*, an HIV activist from Beijing who travels to Bangkok to get PrEP said that "as a gay man, I use PrEP to protect myself against HIV. Not many gay men want to use condoms in China". He notes "PrEP is not [readily] available in Beijing, so I travel to Bangkok to get my PrEP,” he said. Wang Tu emphasises that this is not unusual -- noting that his two friends accompanying him on this current trip to Bangkok were in town for the same reason. "In Beijing, I know dozens of others who travel to Thailand to buy PrEP".
Wang Tu is not the only one. In some countries where the medication for PrEP is approved for prevention (and available for purchase), the price of the drug is so astronomically high that sourcing the drug locally is not a viable option. For these invidiuals, travelling to Bangkok is one of the only affordable ways to access this drug. Such is the case for Park Lee Hyguen*, a South Korean gay man visiting Bangkok to obtain PrEP.
Although South Korea has approved Truvada for HIV prevention, “the drug is still very expensive and is difficult to find in Seoul” explains Park. Like Tu, Park too plans mini vacations to Thailand to see a sexual health specialist in Bangkok and to stock up on his anti-HIV medication a few times a year. “Even by doing this, I am saving money than if I were to buy the medication locally in Seoul” Park said.
Thailand offers easy, and affordable access to PrEP. Generic products can cost as little as USD 40 for a month supply while the brand name product (Truvada) costs upwards of USD 125 per month. In South Korea, generics are not available, and Truvada costs about USD 380 for a one month supply, Park noted.
Park admits that PrEP is a more expensive way of preventing HIV than other methods, but for him, "it is a worthwhile choice, as it provides me with an additional sense of security and feeling of independence". Park's response attests to the fact that PrEP, in addition to serving as a preventative tool, may also play a role in terms of personal empowerment, allowing individuals to overcome the anxiety caused by the epidemic and to take charge of their own sexual health.
While it is a positive sign that people like Park are willing to pay out of pocket to be responsible for their health and the health of their sexual contacts, the ability to protect one's self from HIV should not be limited to only those who have the means to afford expensive drugs or travel abroad for generics.
PrEP represents an opportunity for the provision of prevention toolkits that are more comprehensive than ever before, where individuals can choose and customise a combination of prevention methods that accommodate their practices, lifestyles, and circumstances. While PrEP may not be for everyone, it represents a new prevention tool that should be made available to those who stand to benefit from incorporating it into their own personal preventative strategies.
As of now - not everyone has access to a full range of options. Affordability and access to PrEP remain problematic. This is something we must advocate to change in the Asia-Pacific Region. Everyone should have at their disposal a full range of tools to choose from, regardless of their status or privilege.
*Names have been changed to protect the identity of interviewees.
Click here for tips on travelling abroad to access PrEP.