Let’s face it, many (or most?) online pharmacies have a reputation for being rogue websites that spam inboxes offering cheap sexual enhancers and prescription drugs. Anyone else gotten an inbox full of unsolicited emails about Viagra? But recently online pharmacies have had an increasingly important role in helping many people across Asia and the Pacific access pre-exposure prophylaxis (PrEP).
For some, online pharmacies allow individuals to access PrEP services that they are otherwise unable to get through a local health provider. In the Philippines, formal PrEP services are only locally available through a small demonstration project in the metro-Manila area. Other individuals who live outside the metro-Manila catchment area or for other reasons are unable to participate in the study, have limited options but to order online to access PrEP as a prevention tool. ordering PrEP online provides an alternative means of accessing this prevention tool. “I think it’s awesome that PrEP is becoming available in the Philippines”, said Rafael Vinar, a resident of Cebu City, ”but I was not eligible to be in the study … so instead I buy my PrEP online [through a clinic in Bangkok]”.
For others, online vendors allow individuals to access PrEP the convenience, discretion, and anonymity expected from an online order. "Singapore is a small city and there are only a handful of places I can go to PrEP. I don't want to accidentally run into my co-workers at an STD or HIV clinic while waiting for the doctor to get my PrEP. According to Desmond Lee-- a 32-year-old Singaporean clinician, who asked that we did not use his real name, “I prefer to be anonymous or discrete when it comes to the choices I make regarding my sexual practices"
When your reasons for buying PrEP online is for access, convenience, or discretion, it is essential that you are using PrEP in a manner that is safe and effective. It is essential to do so under medical supervision to help monitor for any side effects or complications with the drug. It will also be essential that the supplier you choose is legitimate, or you run the risk of being scammed with fake pills that do not work or which may cause you great harm.
We've scoured some online resources and spoke to some insiders in the online PrEP vending to find information that might be important for individuals who are considering online vendors for PrEP:
- Get tested for HIV. If you are already positive and you start taking PrEP, you could need additional medications for a full course of treatment which may need to be started as soon as possible. Delaying a full course of effective treatment may make your HIV infection harder to treat in the future! Check out our country status page for places to get tested in your country.
- Get tested for the Hepatitis-B virus (if you haven't already been vaccinated): If you have Hep-B and you start taking medication for PrEP, you run the risk of making symptoms of your Hep-B infection worse when you discontinue PrEP (Ask your doctor about this)
- Get your kidney function tested before starting and at least once every 6-months that you are taking oral PrEP. This includes a blood test for creatinine and eGFR to ensure that your body is able to process and clear the medications used for PrEP. Certain online providers may require documentation from these tests, so be sure to get a copy of the results.
- Get a prescription for your PrEP from your doctor and make sure that what you are ordering is the right medication. Keep in mind that there many different suppliers of the same drug and that this combination of drugs may be called by different things. Make sure that what you are ordering matches the prescription from your doctor. In Asia, PrEP will usually consist of a combination pill of tenofovir and emtricitabine –Truvada is the name of Gilead’s (originator manufacturer) version of this drug combination while Teno-Em, Tenvir EM, and Ricovir-Em are non-originator manufacturers' versions of this drug -- which are cheaper and just as therapeutically effective. Note: Teno-EM is made in Thailand--buy locally and think globally!
- Pick a reputable online pharmacy. Check out our accessing PrEP online to see if we know of any reputable online pharmacies that currently ships to your country.
- Check to see if online pharmacies will deliver to your country. Because of legal restrictions, certain online pharmacies may only be able to ship or guarantee shipment to certain countries -- so check again with the pharmacy before placing your order. (Note: Orders to addresses in China are currently being stopped by Chinese Customs, and there’s nothing we can do about it right now!)
- Verify how much you can order at one time. Some countries may have restrictions or limitations as to the amount of medication that can be shipped or imported via mail. (Japan will only allow for one-month shipment)
- Have your script/paperwork ready. Some online pharmacies will require you to submit a doctor's prescription for PrEP while others may request you to provide the laboratory results of your HIV/Hepatitis-B/Kidney/Liver Function tests directly. Check with your online vendor and make sure you have the paperwork on hand for them.
- Check back in with your doctor every 3-6 months to get tested for HIV and other STIs (as well as to verify for your liver and kidney function). Remember – PrEP may protect against HIV, but it doesn’t protect against other sexually transmitted infections.
- Plan and be patient as your order might take a while (up to a month) to arrive! And in the meantime, keep calm and carry on! And come check out our videos, memes, or other news articles.
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