Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email josescon1@gmail.com or info@outragemag.com.
Dear Doc,
I am HIV positive. We have access to PrEP from overseas, and my HIV-negative BF who is in Manila wants to start using it. How do we go about this?
Serodiscordant BF
Thank you for this question.
Pre-exposure prophylaxis (PreP) is the intake of an antiretroviral prior to an exposure (i.e. sexual) with someone with HIV. Unfortunately, based in the Philippines’ ARV guidelines and policies, PreP use is still not available in the country.
Many developed countries has “authorized” the use of PrEP as HIV prevention among HIV discordant couples (meaning, one of the partners is HIV negative). In the US, for example, the Food and Drug Administration approved the use of Truvada (emtricitabine/tenofovir disoproxil fumarate) to “reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners”.
It is worth mentioning that Truvada is actually already approved as part of ART for people with HIV. The approval given by FDA, nonetheless, was the first time that a drug was given the green light for PrEP – in not so many words, “for protecting uninfected people against HIV”.
It is worth noting that:
- Current recommendations for PreP use entail its intake for life for HIV discordant couples; and
- Truvada was approved for use AS PART OF A COMPREHENSIVE HIV PREVENTION STRATEGY (meaning, those using still need to use other prevention methods such as safe sex practices, risk reduction counseling, and regular HIV testing).
We hope – and expect – to see new/additional evidences/reports that would also shed light on other issues, including: frequency/timing of PrEP intake; and effect/s of “drug holidays” in using PrEP (even eyeing for it to offer the same efficacy).
Now, as for the decision as to start PreP use in the Philippines, the challenges seen here are the access to PrEP, as well as compliance issues.
If, as you stated, PrEP access is not a concern, then a HIV health provider willing to monitor and follow up both you and your boyfriend should be consulted. Remember, PrEP use – in order to have maximum effect – requires commitment, and more importantly compliance.
