In this part of the world, there is still an under-utilisation of the pre-exposure prophylaxis, or PrEP, a drug combination whose primary purpose is to prevent the proliferation of the debilitating HIV/AIDS virus, which first appeared in the 1980s.

PrEP is largely recommended for people at very high risk for HIV and requires them to take a combination of two HIV medicines (tenofovir and emtricitabine) daily to lower their chances of getting infected.

Why is PrEP still underprescribed in Singapore and Malaysia?

While further studies are still needed on this therapy, it has been shown to reduce the risk of HIV infection in people who are at high risk by more than 90%.

Currently, the drug costs S$900 for 30 tablets a month, or $30 per pill, at one clinic in Singapore while in Malaysia, a generic version of PrEP would cost approximately RM180.

Although the prices are currently quite steep, the cost-effectiveness of such a preventive drug cannot be understated. In Singapore, the treatment for antiretroviral drugs is estimated from S$1,000 for the most basic form of medication, to S$2,000 for newer drugs, – for a lifetime – failing to adhere religiously to the treatment as prescribed is akin to a death sentence. Newer drugs do not have the side effects, of nausea, anemia, unusual dreams and depression, that comes with the cheaper drugs.

“PrEP works, it saves money, and most importantly it has the power to prevent HIV acquisition for thousands of people, at the same time as beginning to end the HIV epidemic,” says Deborah Gold of the National Aids Trust.

In addition, the prevention of HIV would be sure to reap dividends for any countries’ public health systems. The end stage prognosis of AIDS is often bleak, and it is well known that AIDS patients requires large amounts of care, and can place undue strains on the public healthcare system.

Is PreP the way forward for HIV treatment in lieu of cure?

Thus, it is of no wonder that there have been fervent calls for national health systems, specifically the United Kingdom’s National Health System (NHS) to provide heavy subsidies, or total subsidies, for PrEP.

Last month, Norway became the first country in the world to offer at-risk citizens the PrEP drug at no cost, as part of its National Health Service, according to Bent Høie, Norway’s minister for health and social care.

With this announcement, Norway joins Canada, France, South Africa, and the United States to offer PrEP to high-risk individuals, but makes history has the first to do so freely.

With this announcement, there have been calls by healthcare professionals in the UK for its NHS to follow suit for individuals at higher risk. However, there has been some opposition to such free-provisions, as with low barriers to procurement, opponents argue that this would encourage risky behaviours, and that such behaviours are condoned.

Downsides of free-provision of PrEP

This also poses a real concern: Why should the state be liable, financially and morally, for an individual’s risky behavior? Some have also argued that such a drug should not be furnished for free in part due to its low efficacy rate of about 90% and that since adherence to medication schedules can be an issue, such a drug should not be provisioned for free.

However, such arguments may have missed the point - and undeniable benefits – on the theory of free-provision of drugs, which is that doing so would bring about positive benefits for the society at large as detailed above, and against those suffering from AIDS who are “hell-bent” on spreading the illness.

While the adherence to medication schedules remains an issue, that is, and should be, an isolated issue that affects all long-term drug consumption, and is one that should be resolved by the healthcare community through other means as urgently as possible. MIMS

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