Make HIV-prevention drug accessible to Hong Kong public, says Aids Concern
Originally published at the South China Morning Post on May 28, 2016.
A pill offering at-risk individuals protection against HIV should be made publically accessible and included as one of the city’s key interventions for fighting the virus, says local health group Aids Concern.
The drug regimen, called pre-exposure prophylaxis or PrEP, can lower the chances of getting HIV from sex by over 90 per cent and from injecting drugs by over 70 per cent if taken daily, according to the US Center for Disease Control and Prevention. The regimen uses a drug called Truvada that is licensed in the city to treat HIV, the virus that can lead to Aids.
“Some people don’t use condoms very much at all and take natural risks with their health despite knowing that condomless sex will put them at risk of HIV,” Aids Concern chief executive Andrew Chidgey said, adding that the government should provide the regimen to targeted at-risk individuals through public hospitals and clinics. “We’d like to see PrEP available as soon as possible.”
The drug is particularly useful for gay or bisexual men who have sex without condoms, drug users who share needles and those having sex with infected people. It could also transform Aids prevention in Hong Kong, which currently relies on condom use, education and HIV-testing.
Local health experts emphasised that PrEP should not be a substitute for condoms, but rather an additional protection. It can also lower the stigma surrounding HIV/Aids victims, for instance by normalising such medication and providing more options for couples in relationships where one partner is infected.
“In [such] a relationship, it’s difficult to move beyond the idea that one person is HIV-positive,” said former Mr Gay Hong Kong Michael Morrill, who is living with HIV. “By allowing HIV-negative people to take PrEP you’re facilitating the level of comfort and easing the stigma against people living with HIV.”
PrEP is currently only offered through private clinics in Hong Kong at a price of about HK$8,500 for one month’s supply.
“[Our patients] are using it as an extra precaution against accidents such as condom breakages,” Neo Health doctor Francois Fong said. The centre began supplying PrEP in late 2014.
In September, the World Health Organisation recommended that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice as part of a comprehensive package of services including HIV testing and condom use. Yet the implementation of PrEP in countries in Asia, including Hong Kong, has been slow.
“Compared to Western countries like the US and Europe, we are lagging behind,” Chinese University research assistant professor Johnson Wang Zi-xin said.
A government-funded study led by Wang revealed that out of 202 local men who have sex with men, only 23.3 per cent had heard of PrEP and just 1.5 per cent had used the medication. While 47 per cent would use PrEP if it was provided for free by governmental hospitals, only 7.4 per cent would buy from private clinics.
Despite the demand, the study also showed that only 31.2 per cent were likely to adhere to daily use, and only 43 per cent were likely to take up HIV testing every three months after taking the regimen. The city needed to conduct more research to see how it could best implement PrEP, Wang said.
Tommy Chen, a 42-year-old Hongkonger, takes PrEP to protect himself in high-risk situations. But the cost of Truvada means he can only afford to take the medication on demand, a less effective means of protection, rather than the recommended daily dosage.
“PrEP gives double safety. The government needs to provide it,” Chen said. “I’m happy that the government is looking into it, but I’m not happy that we must wait for a long time. It has been been proven to be very, very effective. To say we need more studies is an excuse.”