Even without any official numbers, the answer seems to be yes.
Thailand already has a reputation for being a global destination for medical tourism, where patients travel abroad for affordable private health care. But where such services typically refer to high-quality surgery, in recent years, gay men have been arriving in hordes to purchase PrEP on the cheap.
PrEP, or pre-exposure prophylaxis, is a preventive medicine that reduces the risk of getting HIV through sexual intercourse. There is no scientific doubt about its effectiveness; studies have routinely shown its efficacy at 100% if taken as directed.
However, it is still hard to get in many Asian countries. Reasons include a lack of comprehensive sex education, and sheer cost. In South Korea, where new HIV infections have not fallen since 2013, a one-month supply of Truvada, the branded PrEP drug produced by Gilead Sciences, will set you back hundreds of dollars.
Then, there are social and cultural factors.
Taking PrEP is often associated with homosexuality, which is at best tolerated by conservative and religious circles. In many parts of Asia, being gay is still considered taboo.
Dr Yang Chia-Jui of Taiwan’s Far Eastern Memorial Hospital told the Nikkei Asian Review that while it is convenient to get PrEP at hospitals designated for HIV care, only those who qualify for the Taiwan Centers for Disease Control PrEP programme can do so.
To quality, patients must either be under 31 or have an HIV-positive partner. “For those who cannot attend the PrEP program, they have to get PrEP pills at their own expense,” Dr Yang said. Truvada, the only PrEP pill approved in Taiwan, costs $400 per monthly bottle.
In pre-Covid times, this means a flight to Bangkok is in order.
In Thailand, a generic pill, which contains exactly the same ingredients as Truvada and is manufactured by a Thai government agency, costs as little as $20 per 30-day supply.
“The growth of our business has been phenomenal over the past four-plus years, as evidenced by the thousands of patients on record,” said Dr Deyn Natthakhet Yaemim, founder and CEO of PULSE Clinic in Bangkok. The clinic has patients from more than 130 countries.
These days, however, you won’t be leaving your borders anytime soon. And for PrEP-seekers, that means going online.
Yuta Onaga from Colorful Heart, a Tokyo-based self-help group for LGBTQ people that also runs a Japanese PrEP information website, said many Japanese people go online to purchase the generic pill, because there are “lots of barriers” in Japan.
“Most HIV/Aids-related organisations in Japan do not want to promote PrEP.” The stigma of promiscuity and its association with HIV mean that many are reluctant to discuss the benefits of PrEP, and lack of information about PrEP in the local language is another factor.
In China, while the country’s Food and Drug Administration had approved PrEP in 2015 for the treatment of HIV/Aids, it has not been approved for prevention. That means doctors are not allowed to prescribe it to patients unless they test positive for the virus.
Mr Xiao Dong, who runs the Beijing-based non-government organisation Tongzhi which is committed to combating Aids, told The Nation newspaper that he began travelling to Thailand in 2016 for vacations and to stock up on the anti-HIV medicine.
As an openly gay man, he said, health and safety are his top priorities: “I use both condoms and PrEP to guard against HIV,” he said, adding that he knows nearly 100 men from Beijing who have also travelled to Thailand to purchase PrEP.
“It’s a positive sign that our community has become more responsible for our own health, and each other’s. They are willing to pay out of pocket,” he said.
