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#PrEParingAsia: How PrEP is expanding in Asia through innovation

by Antón Castellanos Usigli, September 14, 2018

APCOM is a coalition of community-based organizations, non-for-profit organizations, UN agencies and governments based in Thailand that focuses on addressing HIV issues that affect men who have sex with men (MSM) and transgender people. They are a long-standing pioneer in advancing the sexual health of key populations across Asia and the Pacific.

I first became acquainted with them while working at the HIV Department of the Western Pacific Regional Office of the World Health Organization (WHO) in Manila, Philippines, back in 2014. In November of that year, and under the mentorship of Dr. Zhao Pengfei, I collaborated in the organization of a meeting to roll out the new WHO Consolidated Guidelines on HIV prevention, diagnosis, treatment and care for key populations, which feature Pre-Exposure Prophylaxis (PrEP), a daily pill that prevents HIV that was fairly new at the time (the US Food and Drug Administration approved it in 2012).  Although the US is the only country where PrEP has reached hundreds of thousands of people, now it has expanded to different countries and more keep joining the list thanks to emerging demonstration projects and clinical trials.

Midnight Poonkasetwattana, APCOM’s Executive Director. Courtesy of APCOM

I recently talked with Midnight Poonkasetwattana, Executive Director of APCOM, about the situation of PrEP in Asia and specifically in Thailand: “PrEP is available in a number of countries across Asia and efforts are being made to make PrEP as accessible as possible to MSM throughout the region.  APCOM is one of the regional organizations working with country partners to promote PrEP in the region. Most people are accessing PrEP through demonstration projects or clinical trials. Some are purchasing the drug online (with the help of organizations that are facilitating online ordering for clients who wish to purchase the drug in jurisdictions where it can be legally sold). Others, who can afford it, are travelling to Bangkok to get PrEP through the Thai Red Cross Clinic, Silom Clinic or private clinics.”

A few years ago, APCOM started the Test Bangkok (Test BKK) campaign in Thailand, with the motto “Suck, F*#K, Test, Repeat”. The campaign is sex positive and features very funny and explicit videos that depict different situations related to anal sex, dating and hooking up among gay men. It also includes information about PrEP availability across four Thai cities: Bangkok, Pattaya, Chiang Mai and Hat Yai.

Agencies like NIAID, USAID, PEPFAR, UNITAID, Thai Red Cross AIDS Research Centre, FHI 360 and the Thai Red Cross AIDS Research Centre are currently funding PrEP programs in Thailand. People can access it for 30 baht per day (0.92 USD), which adds up to 900 baht per month (28 USD).

For Midnight, education and promotion of PrEP, as well as funding, are the most significant barriers to scale access  in Asia: “Given the pressure on national health budgets, innovative and multifaceted funding models will need to be developed with the community to make PrEP more widely available. APCOM is working on disseminating accurate information regarding PrEP, making stories and experiences of people who have benefited from using PrEP widely available, collating data from pilot projects from other countries, and producing strategic information for PrEP advocacy and implementation.”

Test BKK PrEP Ad. Courtesy of APCOM

In 2015, APCOM hold the meeting PrEPARING Asia, which brought together activists, policymakers and service providers to discuss how to scale up PrEP access in the region, and recently, it released PrEPMAP, a digital platform that aims to expand knowledge about the current status of PrEP in Asia and the Pacific. It includes breakdowns, for example, of the countries where it is locally available, available only through online purchasing and even lists import restrictions.

With these innovative initiatives, APCOM is stepping up as the main PrEP champion in the region, but the road for full access is still long and complex. Another challenge, as recognized by Midnight, is stigma: “We have empirical evidence that PrEP users in Thailand feel stigma and judgement about using PrEP. There are assumptions by peers and others (including some service providers) that PrEP users are either within a serodiscordant relationship or intending to have increased numbers of sexual partners. This is similar to reports of slut-shaming in the US, which are all barriers to successful implementation of PrEP in the region.”

PrEP is more than a prescription. Courtesy of: APCOM