A 2018 PrEP MAP update on the status of PrEP in the Philippines and Malaysia.
Although online pharmacies have had a reputation for being rogue websites that spam inboxes with offers of cheap sexual enhancement (Viagra!) and other prescription drugs (Valium!), they have recently played an important role in helping individuals in the Asia-Pacific region access medications that help reduce the risk of HIV transmission. This is particularly the case in countries such as the Philippines and Malaysia, where PrEP has only recently become formally available through local pilot and demonstration projects.
In the Philippines, PrEP is only available through Project PrEPPY (PrEP Philippines), a demonstration project examining the feasibility of community-based, peer-driven delivery models of PrEP services for men who have sex with men (MSM) and transgender women. The project was launched in June of 2017 and is being implanted by the Manila-based community-based organisation the LoveYourself. The study provides 200 eligible participants with PrEP and has recently finished enrollment.
For individuals like Rafael Vinar and other gay Filipinos who live outside the metro-Manila catchment area or for other reasons are unable to participate in the study, ordering PrEP online provides an alternative means of accessing this prevention tool. “I’ve heard about the Project, and I think it’s awesome that PrEP is becoming available in the Philippines”, said Rafael “But I live in Cebu City, and so I was not eligible to be in the study”.
"I actually used to travel to Bangkok to get my PrEP” he explained, "but I found out that the clinic I go to delivers PrEP to the Philippines--so I can just order my refills online. The convenience of getting it delivered to me is awesome. It saves me so much time and hassles".
Although Malaysia has also recently introduced PrEP, it is becoming available in a growing number of private and public clinics (some of which are listed on our page). The University of Malaya Medical Centre provides PrEP for about RM 40 per month since December of last year and is conducting a PrEP study among MSM where eligible participants are given free PrEP for a year.
In Malaysia PrEP is becoming increasingly available in a growing number of private and public clinics (some of which are listed on our page). "There has been an increasing number of PrEP services in Malaysia, which is in part due to doctors responding to increasing demand from the community,” says Dr Iskandar Azwa, who works with the University of Malaya in the Infectious Diseases department, and a strong proponent of PrEP. “However, there are still pockets of the country that do not have access to PrEP related information or services, which is where online pharmacies and other initiatives can lend their support" he added. "We should be promoting new initiatives that are facilitating access to PrEP and other HIV-services" he added.
While it is encouraging that online pharmacies help facilitate access to PrEP for individuals who may otherwise not have access, they are no substitute for progressing the implementation of PrEP in both countries at the national and local levels. It is unclear if and to what extent those who purchase PrEP online are linking to care and receiving the level of supervision recommended for initiating and maintaining a PrEP Program. The extent by which online retailers enforce or follow these recommendations varies by retailer, and the question of who would be held responsible should any issues or complications arise from poor adherence or tolerance to the drug, remains unclear. It will be important for both governments to work towards the regulatory approval of antiretrovirals for prevention and towards the inclusion of PrEP into national health programs and clinical guidelines to ensure that PrEP use in these countries is safe and effective, regardless of where it was purchased online or not.