Pre-Exposure Prophylaxis (PrEP) - HIV Prevention In Malaysia

What is PrEP?

PrEP is a daily pill that reduces the risk of HIV infection. It's a drug that works in the same way as malaria prevention tablets or birth control pills.

This is not to be confused with PEP, which stands for Post-Exposure Prophylaxis. It is used after a person has been diagnosed with HIV.

PrEP is a highly effective HIV prevention technique when taken on a regular basis. PrEP, when taken regularly, decreases the risk of contracting HIV from sex by around 99 percent, according to studies. When taken regularly, PrEP decreases the risk of contracting HIV by at least 74% in people who inject drugs. If PrEP is not taken on a regular basis, it will be ineffective.

Who should take PrEP?

If you test negative for HIV and any of the following apply to you, PrEP might be right for you:

1. You have had anal or vaginal sex in the past 6 months and also:

   1. have a HIV-positive sexual partner, especially if the partner has an unknown or detectable viral load

   2. have been practising unprotected sex

   3. have been diagnosed with sexually transmitted disease in the past 6 months

2. You share needles, syringes or other equipment to inject drugs

3. You have been prescribed PEP before and also:

   1. reported continuous high-risk behaviour

   2. have been on multiple courses of PEP

4. You are a woman considering to get pregnant and have a partner with HIV.

What are the drugs in PrEP?

PrEP drugs are made up of two different types of antiviral medications:

1. Emcitarabine

2. Tenofovir disoproxil fumarate

These tablets are sold under the brand name Truvada.

How effective is PrEP?

Different sexual orientation categories have different protection rates, for the most part. According to the four studies included in the US Centres for Disease Control and Prevention's Interim Guidelines, PrEP provides HIV protection in the range of 50% to 84%. In other journals, protection rates as high as 99% have also been documented.

All must remember that PrEP is only one of the many HIV prevention strategies available. Having said that, PrEP is not fail proof and should be used in conjunction with other preventative measures such as:

• regular practice of protected sexual intercourse (e.g.: proper condom usage).

• getting proper treatment for HIV infected partner.

• avoid exchanging or sharing needles and other injecting equipment.

How to start PrEP?

If you think PrEP might be right for you, consult with a doctor. Only a health care provider can prescribe PrEP.

You must first take an HIV test to ensure that you are HIV-free before starting PrEP. It is recommended that you take these tablets for at least 7 days before engaging in any potentially dangerous activities.

You'll need to see the doctor every three months for follow-up appointments, HIV testing, and prescription refills when on PrEP. You can take the PrEP medicine for as long as you want. It is strongly recommended that you take it for as long as you are at risk of contracting HIV.

You may feel the need to stop taking PrEP if:

• you change your lifestyle making your risk of getting HIV becomes low.

• you have side effects from the medicine that are causing nuisance to your life.

However, it is recommended that PrEP to be continued for at least 4 weeks after the last high-risk encounter. It's also a good idea to have HIV and other STD screenings three months after the last risky incident. Remember that PrEP just reduces the risk of HIV, not the risk of other STDs.

The other options is by taking “On-demand” PrEP— also known as PrEP 2-1-1—is an alternative method of dosing that may speak to these concerns, making PrEP an option for more people than ever before. PrEP 2-1-1 is named for its schedule of dosing: 2 pills are taken 2-24 hours before sex, 1 pill 24 hours after the initial dose, and one final dose 24 hours later

What are the side effects of PrEP?

The majority of patients have little or no negative side effects. Even if they do appear, they are typically mild side effects that are easily treated.

Minor side effects include:

• Headaches

• Nausea

• Loss of weight

The following are some of the more major side effects which are rare:

• Kidney impairment

• Impact on bone density

Frequently Asked Questions (FAQs)

1. Can I stop using condoms if I am taking PrEP?

PrEP protects against HIV but not towards other sexually transmitted infections. Other STDs that can be transmitted by genital fluids, such as gonorrhoea and chlamydia, can be prevented with condoms. Thus, it is strongly advised for you to continue engage in safe sexual practice while on PrEP.

2. If I do not have the ongoing risk of getting HIV, can I take PrEP only when I am at risk?

There is a method called “on-demand PrEP” which allows you to take Truvada using the 2-1-1 schedule. This means taking 2 pills 2 to 24 hours before the intended intercourse, 1 pill after 24 hours of the first dose, and 1 pill 24 hours after the second dose.

If you are already exposed,you may want to consider POST EXPOSURE PROPHYLAXIS (PEP)