amfAR, The Foundation for AIDS Research

Expanding Pre-Exposure Prophylaxis (PrEP) for HIV in Thailand

An Adam’s Love user poses outside the Anonymous Clinic after receiving an HIV test.
Adam’s Love celebrity ambassador Tack Pharunyoo poses outside the Anonymous Clinic after receiving an HIV test.

HIV rates are rising among men who have sex with men (MSM) and transgender individuals across the Asia-Pacific. In Thailand, MSM will soon account for over 50% of new HIV infections, and in Bangkok, approximately one-third of MSM are already living with the virus. While precise national data are not available for transgender individuals, epidemiologists have hypothesized that the rates are likely even higher.

This spring, in an effort to enhance national HIV prevention efforts, the Thai Red Cross AIDS Research Centre and Adam’s Love, Thailand’s leading Internet and social media-based HIV outreach initiative, are working on two groundbreaking endeavors to bring oral pre-exposure prophylaxis (PrEP) to MSM at higher risk of HIV infection in Thailand. Both projects are supported in part by TREAT Asia.

The U.S. Food and Drug Administration approved the use of the combination antiretroviral therapy (ART) tenofovir and emtricitabine as PrEP in 2012. However, three years later, PrEP remains largely inaccessible in most countries worldwide, despite the fact that multiple studies have demonstrated that the intervention can reduce the chance of HIV infection among higher-risk individuals by up to 90%.

“The fact that, throughout the world, there are still two million new HIV infections each year shows that we really need to use new tools to reach everyone; however, too few countries are providing or promoting PrEP, and too few people at higher risk for HIV are aware of its benefits,” says Kent Klindera, director of amfAR’s GMT Initiative. “Adam’s Love and the Thai Red Cross’s efforts are exciting and will hopefully not only drive down new HIV infections there, but also lead more countries to adopt similar programs.”

An Adam’s Love Facebook post promoting the PrEP-30 campaign. An Adam’s Love Facebook post promoting the PrEP-30 campaign. Adam’s Love’s PrEP-30 campaign is Thailand’s first major effort to spread awareness about PrEP and how it works and encourage MSM who are at higher risk of HIV infection to consider using it. The campaign also informs them that PrEP can now be obtained at the Thai Red Cross’s Anonymous Clinic for MSM and transgender individuals at the cost of 30 Baht (about $1) per day. This is currently the only location in Thailand where PrEP can be accessed at this low cost.

“Before we launched this campaign, we had received a total of two PrEP-related inquiries from MSM, and they had learned about PrEP from a Thai Red Cross counselor,” says Tarandeep Anand, director of Adam’s Love. “Now, PrEP awareness among MSM and transgender individuals in Thailand is increasing rapidly, and we receive at least one PrEP-related inquiry daily through Adam’s Love’s online counseling and support channels.” He adds that all individuals who inquire about or purchase PrEP are offered risk-reduction counseling that emphasizes the importance of using it in conjunction with condoms.

While 30 Baht a day is affordable for some of Adam’s Love’s clients, the cost may still be prohibitive to clients most in need. Dr. Nittaya Phanuphak is leading a Thai Red Cross study on the uptake and efficacy of PrEP among Thai MSM and hopes the findings from her research will encourage the Thai government to cover the cost of PrEP under Thailand’s National Health Insurance.

The study, which began enrolling participants in May, will look at PrEP uptake among up to 600 MSM in Bangkok, Pattaya, and Pathumthani, and evaluate which delivery models most effectively encourage adherence to HIV prevention regimens. Dr. Phanuphak says she was inspired to start the study after her team discovered that 6% of MSM participating in another Thai Red Cross research project who tested negative for HIV one year, tested positive the next.

“This is a very high incidence in an area that has high-quality risk-reduction counseling, condom and lubricant provision, and post-exposure prophylaxis (PEP),” she says. “After this, all of us working in this field in Thailand agreed that it is time for us to really take PrEP seriously as part of the combination prevention package needed for MSM and transgender individuals.”