A lot has changed since the peak of the HIV/Aids epidemic in the 80s. Today, there are a multitude of drugs that people can take to prevent and treat HIV, such as PrEP, a HIV-prevention strategy that when taken correctly, is close to 99% effective in preventing HIV.
But despite its clear advantages, PrEP drugs continue to be under-utilised by the people who need it most – namely, gay and bisexual men, transgender women, and injection drug users.
Only 4% of gay and bisexual men in the United States use PrEP drugs, according to a 2018 study. There are no comprehensive figures for PrEP use in Asia – though, China has just approved Truvada for PrEP use in a stunning victory for the country’s LGBT activists.
Because Truvada has been in the market for some time, its safety and effectiveness are well-tested. Descovy, another HIV-prevention drug, is newer to the market and may not be for everyone. The drug has only been tested in cisgender gay and bisexual men and transgender women; others in at-risk groups might want to stick to Truvada or its generic version.
So, if PrEP is so effective, why aren’t more people using it?
One factor is cost. The list price for a month’s supply of Truvada is almost US$2,000. Generic drugs often cost less than brand-name drugs, but the generic version of Truvada costs US$1,455 — only about 25% less than the branded drug. A more substantial price drop is expected in 2021 as more drug companies enter the generic drug market.
That said, the cost of PrEP varies country by country. In Asia, many people tend to travel to Bangkok for their supply, where it can cost as little as $20 for a 30-day supply. See our story on PrEP in Bangkok here.
What are other hurdles besides PrEP’s high price tag?
There are cultural and behavioral barriers, too – shame, for example. In Asia and around the world, there is still a lot of stigma about HIV and PrEP. Oftentimes, people find it uncomfortable to talk about it, whether to their friends, family or even doctors. You’ll even find that some healthcare providers would also prefer not to talk about it, making it even less likely for patients to seek and find the right information.
One other reason is that people tend to underestimate the risk of contracting HIV. Even though people know that the risk of infection exists, some potential patients don’t associate that with their own personal risk, said Kevin Robert Frost, the chief executive of amfAR, one of the world’s largest AIDS research foundations.
For example, people in monogamous relationships may downplay the risk of HIV, and think that they don’t need PrEP, he said. “The very communities that need it the most are the ones who are getting this the least.”