PrEP (HIV infection prevention) therapy ... is it available in Thailand?

[Jingthing]

As many people who are HIV negative and may be at higher risk of infection know already, PrEP therapy is becoming more widespread in the west among high risk groups. Especially gay couples, where one partner is negative and the other positive.

So my question is this -- what is the status of PrEP now in Thailand?

Is this available to high risk Thais under their government health plan?

If so, does that mean no cost to them?

What if an expat wants to do PrEP in Thailand? If the meds are available, what would the retail COST be in Thailand?

If PrEP is not available in Thailand, what is the reason for that?

Considering that Thailand has in no way beat HIV and the continued high rates of new infections among high risk Thais, I think it's a question worth asking.

http://www.advocate.com/31-days-prep/2014/10/23/can-prep-change-global-fight-against-hiv

Can PrEP Change the Global Fight Against HIV?

Pre-exposure prophylaxis, or PrEP, could help change the tide on new HIV infections worldwide. But that's only if the most at-risk populations can access the treatment.

Thanks for any information about this.

Not to take the thunder from Ebola, but currently HIV is a much bigger current threat to people living in Thailand.

Edited October 23, 2014 by Jingthing

[NeverSure]

I've never heard of that, JT. Glad to hear it's out there. I'll give my best wishes that it's available in Thailand.

[Jingthing]

It's quite controversial and is not suitable for everyone. I'm sure there are side effects to taking the meds and also there is the morality argument. Some have argued it encourages people to be less safe in practices, even giving stigmatic labels to people who use it (slurs for sexual promiscuity). But over time it appears to be shown effective in some target groups. I am curious if these "morality" objections translate into Thai cultural morality which is of course not the same as western.

But that social part is probably too much for this forum.

To start here, it would be good to know some BASIC INFO about the medical therapy part of it in regards to its current status IF ANY in Thailand?

Edited October 23, 2014 by Jingthing

[EmptyHead]

I believe the Silom Community Clinic may offer it. I believe they had a study/experiement ongoing on PEP not so long ago.

12th floor of the Hospital of Tropical Diseases. Near Victory Monument BTS.

Free clinic for MSM. They even offer NAAT tests for free routinely (every patient, every visit). This test is 99.99% accurate after 10 days, by the way. They are a research center for some American organaization. They frequently have studies going on and are just as good as Thai Red Cross Anonymous Clinic (also a research center) who offer virtually all the same things, except they charge (a very small amount).

However, Silom Community Clinic is usually much quieter. The staff have more time to spend chatting with you and it's more friendly than the Thai Red Cross Anonymous Clinic, where you are often treated quickly, curtly, and coldly.

The Silom Community Clinic is also "anonymous", in case that matters to some people.

[umbanda]

In Thailand the "high risk" population is not just the gay community, its is the ALL Thai population. Most, and in ALL social classes, do not have any knowledge and concerns about HIV infection.. To have sex with ANY Thai without protection, is playing with death.

Edited October 24, 2014 by umbanda

[h90]

It's quite controversial and is not suitable for everyone. I'm sure there are side effects to taking the meds and also there is the morality argument. Some have argued it encourages people to be less safe in practices, even giving stigmatic labels to people who use it (slurs for sexual promiscuity). But over time it appears to be shown effective in some target groups. I am curious if these "morality" objections translate into Thai cultural morality which is of course not the same as western.

But that social part is probably too much for this forum.

To start here, it would be good to know some BASIC INFO about the medical therapy part of it in regards to its current status IF ANY in Thailand?

Well I know that it was available for nurses in my home country and it was never controversial. Thing was at that time that it isn't 100% and that the medication is very heavy, surely not healthy to use unnecessary.

"Encourage to less safe practice"? You can't ban some major help, let some people get HIV even it could be prevented just to encourage safe practice, that argument is so cynical it could come direct from Nazi Germany.....

A couple with one HIV, no matter gay or not gay also may have other situations, say accidents a fallen glass bottle and walking barefoot could be enough that one steps direct in a bloody glass part. What safe practice is against that?

[Sheryl]

It is available from a private doctor. Not available free under the Thai national health care AFAIK, at least not yet (except of course to health workers for occupational exposure).

Can't say re cost but as the tretament is only for a couple of months can't be thst bad. Note that this is for isolated exposures.

[Jingthing]

Thanks Sheryl, but I'm talking about something else entirely. Sorry if I didn't make that clear enough before.

I am not talking about a short term therapy after suspected exposure. This is a new trend which is really growing abroad ... for people who are not infected to be on the meds indefinitely as long as they are in a high risk group. It is especially attractive to mixed HIV status couples.

Given that Thailand has basically FAILED in stemming the tide of new infections in risk groups, why isn't this is a thing in Thailand (at the national level) assuming now that it isn't?

Pre-exposure prophylaxis, or PrEP, is a prevention option for people who are at high risk of getting HIV. It’s meant to be used consistently, as a pill taken every day, and to be used with other prevention options such as condoms. Find out if PrEP is right for you.

http://www.cdc.gov/hiv/basics/prep.html

[Jingthing]

It's quite controversial and is not suitable for everyone. I'm sure there are side effects to taking the meds and also there is the morality argument. Some have argued it encourages people to be less safe in practices, even giving stigmatic labels to people who use it (slurs for sexual promiscuity). But over time it appears to be shown effective in some target groups. I am curious if these "morality" objections translate into Thai cultural morality which is of course not the same as western.

But that social part is probably too much for this forum.

To start here, it would be good to know some BASIC INFO about the medical therapy part of it in regards to its current status IF ANY in Thailand?

Well I know that it was available for nurses in my home country and it was never controversial. Thing was at that time that it isn't 100% and that the medication is very heavy, surely not healthy to use unnecessary.

"Encourage to less safe practice"? You can't ban some major help, let some people get HIV even it could be prevented just to encourage safe practice, that argument is so cynical it could come direct from Nazi Germany.....

A couple with one HIV, no matter gay or not gay also may have other situations, say accidents a fallen glass bottle and walking barefoot could be enough that one steps direct in a bloody glass part. What safe practice is against that?

You have misunderstood what I'm talking about. Sorry again if I didn't communicate it better before. See post above. This is not about nurses who have been had a needle accident. This is about long term therapy.

I'll ignore your Nazi comment. How absurd and unnecessary.

The morality argument against PrEP which is not my argument but has been made is that there is the concern that if people are on the PrEP therapy that they will feel protected by the PrEP and behave more irresponsibly than they would if they weren't. People who are given PrEP are encouraged to continue with safe practices (such as safe sex, not sharing needles) in ADDITION to the PrEP.

Edited October 24, 2014 by Jingthing

[sfokevin]

The Thai Red Cross near Silom sells Truvada and a Generic called Ricovir-EM - you just need a perscription from a doctor.

27. TDF 300 mg + FTV 200 mg (Original)

Trade Name: Truvada
Price/Tablet: 70 THB
Price/Bottle: 2,100 THB (30 tab)

28. TDF 300 mg + FTV 200 mg (Generic)
Trade Name: RICOVIR-EM
Price/Tablet: 34 THB
Price/Bottle: 1,020 THB (30 tab)

http://www.adamslove.org/en-d.php?id=73

[Jingthing]

Thanks for that.

Are those the exact meds and dosage used now in the west for CONTINUED therapy, as opposed to short term program used after one suspected exposure?

[BruceMangosteen]

In Thailand the "high risk" population is not just the gay community, its is the ALL Thai population. Most, and in ALL social classes, do not have any knowledge and concerns about HIV infection.. To have sex with ANY Thai without protection, is playing with death.

That's an odd reply. Most farangs go around having unprotected sex with Thai ladies(and ladyboys) all the time, some even daily. The myth about HIV transmission risks has been played out and debunked. Yes, there is a risk but humanity chooses to ignore it and goes on. I've had friends die of AIDS and some currently HIV positive but this doesn't stop anyone I know(other than those HIV positive) from having continued unprotected sex with mostly females.

Regarding the OP's question, my understanding of the Social insurance coverage most Thai's are on is it is only for treatment of illness, not for prevention, check ups, etc.. It hasn't evolved to yearly physicals etc..

[Sheryl]

Sorry I missed the "r" in there.

Not being done in Thailand AFAIK except possible in trials.

Thailand has not "basically failed" in stemming new infections. rate of new infections has come way, way down.

[Jingthing]

The demographics of HIV infection varies, country to country. A virus doesn't care about your sexual orientation or anything else about you really. In some countries in Africa because of practices there, it is mostly a disease associated with heterosexual sex. Without getting into details about risk groups in Thailand, it is fair to say that sexually active gay men in Thailand and also transgender Thais, whether commercial sex workers or not, are in a high risk group based on their sexual behaviors. No it certainly does NOT only concern sexual minority groups here, of course, and no, sadly, condoms do not work 100 percent of the time and real life people do not use them (properly) 100 percent of the time either.

Anyway, I suggest mostly sticking to the topic described in the OP ... the availability (and cost) of LONG TERM PrEP in Thailand. I think I am hearing this isn't really a thing here (the long term therapy part) and I find that very interesting as well, and worth discussion, again considering the massive failure in Thailand of cutting down new infection rates in high risk groups. What has been recently done isn't working, so why not more PrEP?

Edited October 24, 2014 by Jingthing

[Jingthing]

Sorry I missed the "r" in there.

Not being done in Thailand AFAIK except possible in trials.

Thailand has not "basically failed" in stemming new infections. rate of new infections has come way, way down.

OK, thanks.

I have heard differently from news reports of shocking rate of new infections among young Thai gay and transgender men, sex workers or not.

Thailand was doing real well for years, but seems to have really slipped in recent years. At least according to the news that I have read.

Regardless of the actual truth on the rate of slippage (or not) in stopping new infections here, surely some specific individuals, like mixed HIV status couples and male sex workers would be just as much apt candidates for PrEP as their counterparts in the west, in my opinion anyway.

In any case, don't worry, there is no reason to make this thread about politics as I know that is not supported on this forum.

I respect the MEDICAL focus of this forum and you have really answered the question about lack of availability of this therapy in Thailand. I don't like the answer and I don't understand why this isn't being accelerated in Thailand, but the question has indeed been answered.

Thank you very much

Edited October 24, 2014 by Jingthing

[mania]

Thanks for that.

Are those the exact meds and dosage used now in the west for CONTINUED therapy, as opposed to short term program used after one suspected exposure?

I think it is a either... or, as the 1st drug is what they give according to this article & the 2nd is a generic equivalent.

I saw this topic & googled the name you gave PrEP

The article said

http://www.cdc.gov/hiv/prevention/research/prep/

Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV

but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day.

The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are

used in combination with other medicines to treat HIV.

When someone is exposed to HIV through sex or injection drug use,

these medicines can work to keep the virus from establishing a permanent infection.

From all I have read about HIV the sad part IMHO is if those who are at high risk would get tested

often they would get help sooner if infected, live longer lives & most important of all pose little to no risk to others

since a person on treatment is said to have very low to undetectable viral loads.

There was one study I forget where that concluded it was virtually not possible to get it from one on antivirals? I think it was a French Study but

have forgotten where I saw it.

Here is something similar from WHO which shows a marked decrease in transmission

Not completely but 96% is a pretty good decrease.

Antiretrovirals reduce transmission of HIV

In 2011, a large multi-country study by the HIV Prevention Trials Network showed that antiretrovirals (ARVs)

cut transmission of HIV by 96% within couples where one partner is HIV-positive and the other is not infected. A later study in South Africa reinforced these findings.

When people take antiretrovirals, the amount of HIV in their body is decreased, making them much less likely to pass the virus to others,

says Dr Gottfried Hirnschall, Director of the HIV Department at WHO. If we can get, and keep,

more people on treatment, and reduce their virus levels, we can reduce the number of new people who are infected.

Also although an older article (2years) Seems to also talk a but about what your describing

http://www.who.int/mediacentre/news/releases/2012/hiv_medication_20120718/en/

Edited October 24, 2014 by mania

[Bernard Flint]

In Thailand the "high risk" population is not just the gay community, its is the ALL Thai population. Most, and in ALL social classes, do not have any knowledge and concerns about HIV infection.. To have sex with ANY Thai without protection, is playing with death.

Bit of a silly post Sir????

what about a thai virgin????

[Jingthing]

Any high risk people who may be interested in learning more about PrEP which basically as I've learned is about the medication called TRUVADA might want to follow the comprehensive coverage The Advocate is giving it.

The Advocate is in the middle of doing a long series of articles about PrEP ... :

http://www.advocate.com/31-days-prep

I was particularly interested in side effects as it does sound radical to take a strong med without actually having a disease.

http://www.advocate.com/31-days-prep/2014/10/20/what-expect-when-youre-prep

You may experience some side effects, and you may need to see your doctor more often than usual when you first go on PrEP so he or she can monitor you for side effects. The most common side effects of Truvada when used for PrEP are headache, abdominal pain, and weight loss. If these don’t go away quickly or become severe, contact your physician. But don’t stop taking your Truvada without asking the doc.

The more serious side effects include an excess of lactic acid in the blood, serious liver problems, new or worsening kidney problems (and possibly kidney failure), and worsening of hepatitis B infection. If you have serious kidney trouble, you should not be taking Truvada, so your doctor may want to check your kidney function before you start your regimen. You can read more about the symptoms of these health problems here and here. Again, contact your doctor if you have any of these symptoms, but don’t stop taking your medication without an OK.

Edited October 25, 2014 by Jingthing

[wpcoe]

"If you have serious kidney trouble, you should not be taking Truvada, so your doctor may want to check your kidney function before you start your regimen."

That wording is a bit disturbing. If someone with serious kidney trouble should not take Truvada, shouldn't the doctor *definitely* be *required* to check kidney function before prescribing it?

[mania]

I was particularly interested in side effects as it does sound radical to take a strong med without actually having a disease.

So.....If a person catches HIV they take this drug

If a person that does not have HIV, but wants to protect against it, they will also take this drug??

Why?

The end result would be the same....Taking this strong drug I mean

Wouldn't a high risk person be better off being tested every 6 months & if ever did become

HIV+ just then start taking this drug? Seems their odds are better to avoid any organ problems

due to these types of drugs & they may never need this drug.

When I first saw this news I thought it might be something more positive for prevention.

This seems more like a shotgun approach. Like....well your likely to eventually need this in

your life so just start taking it now?

Edited October 26, 2014 by mania

[Jingthing]

That's pretty ridiculous. If it works you avoid getting a horrible disease. Having to take meds is not the only downside of having HIV in the long run. HIV meds are not a cure. Be clear that PrEP is only for very high risk individuals. Unfortunately that includes a lot of people.

I recently read that use of this globally among high risk people would prevent a million infections.

Sent from my Lenovo S820_ROW using Thaivisa Connect Thailand mobile app

Edited October 26, 2014 by Jingthing

[mania]

That's pretty ridiculous. If it works you avoid getting a horrible disease. Having to take meds is not the only downside of having HIV in the long run. Be clear that PrEP is only for very high risk individuals. Unfortunately that includes a lot of people.

Sent from my Lenovo S820_ROW using Thaivisa Connect Thailand mobile app

Sorry did not mean to imply HIV was not a terrible disease.

But I knew a woman who became HIV infected in the US years ago due

to a blood transfusion during child birth.(dislodged Placenta lost her 7 units)

Because she found out early it was for her... at least so far.... the taking of meds with no other

problems.

But her worry has always been that the meds could eventually cause organ problems & she is often checked for

that. Kidney/liver functions etc.

So in my mind taking these drugs as a "precaution" did not seem to be a great prevention.

But I guess it is something....better than existing precautions given those risks? Not sure.

Edited October 26, 2014 by mania

[Jingthing]

It's a personal risk reward calculation. It still seems troubling to me why Thailand seems so behind the trend on more people at least considering this therapy.

I agree. It's not great. But at this point no cure and no vaccine so all we've got is prevention

Sent from my Lenovo S820_ROW using Thaivisa Connect Thailand mobile app

Edited October 26, 2014 by Jingthing

[PMNL]

I actually think thailand is not behind on the Pre-exposure recommendation. Most of the ID specialist/ internists are pretty upto date and follow the recommendation from the western HIV a organization regularly. They have seminar and work shop yearly for the thai ID Drs and small seminar at each med school very often. It is a purely money issues here. In private practice, high risk patients are advised on their options. Unfortunately in government setting the drug regimen they use is considered to be 2nd-3rd line drugs, full of side effects so most Drs know better not to poison the healthy individuals with those drugs that's why they do not even bother to tell the patients this option for the time being.

[Jingthing]

I actually think thailand is not behind on the Pre-exposure recommendation. Most of the ID specialist/ internists are pretty upto date and follow the recommendation from the western HIV a organization regularly. They have seminar and work shop yearly for the thai ID Drs and small seminar at each med school very often. It is a purely money issues here. In private practice, high risk patients are advised on their options. Unfortunately in government setting the drug regimen they use is considered to be 2nd-3rd line drugs, full of side effects so most Drs know better not to poison the healthy individuals with those drugs that's why they do not even bother to tell the patients this option for the time being.

Specialists would mostly be seeing people ALREADY infected, correct?

PrEP is about reaching people NOT YET infected.

A different population.

According to earlier post, it is available here and not particularly expensive. In Bangkok anyway.

What about all over Thailand?

Where is the public information campaign about this option?

Does it exist?

27. TDF 300 mg + FTV 200 mg (Original)

Trade Name: Truvada

Price/Tablet: 70 THB

Price/Bottle: 2,100 THB (30 tab)

28. TDF 300 mg + FTV 200 mg (Generic)

Trade Name: RICOVIR-EM

Price/Tablet: 34 THB

Price/Bottle: 1,020 THB (30 tab)

Government policy?

So government policy is not to pay for Truvada or the Generic?

Why is that?

Is there something wrong with the Generic?

Again, I still suspect Thailand is behind on this issue of PrEP for whatever reason(s).

No, I don't know that for sure, but I don't think you shed much light on this either.

I really would like to understand.

Based on the WHO many infections in the world (and of course Thailand where HIV rates of infection are high in high risk groups) would be prevented with use of PrEP in high risk group people.

If this lack of PrEP for the higher risk population is only about cost savings ... well, treatment of the infected is a lot more expensive.

Edited October 26, 2014 by Jingthing

[PMNL]

I actually think thailand is not behind on the Pre-exposure recommendation. Most of the ID specialist/ internists are pretty upto date and follow the recommendation from the western HIV a organization regularly. They have seminar and work shop yearly for the thai ID Drs and small seminar at each med school very often. It is a purely money issues here. In private practice, high risk patients are advised on their options. Unfortunately in government setting the drug regimen they use is considered to be 2nd-3rd line drugs, full of side effects so most Drs know better not to poison the healthy individuals with those drugs that's why they do not even bother to tell the patients this option for the time being.

Specialists would mostly be seeing people ALREADY infected, correct?

PrEP is about reaching people NOT YET infected.

A different population.

According to earlier post, it is available here and not particularly expensive. In Bangkok anyway.

What about all over Thailand?

Where is the public information campaign about this option?

Does it exist?

27. TDF 300 mg + FTV 200 mg (Original)

Trade Name: Truvada

Price/Tablet: 70 THB

Price/Bottle: 2,100 THB (30 tab)

28. TDF 300 mg + FTV 200 mg (Generic)

Trade Name: RICOVIR-EM

Price/Tablet: 34 THB

Price/Bottle: 1,020 THB (30 tab)

Government policy?

So government policy is not to pay for Truvada or the Generic?

Why is that?

Is there something wrong with the Generic?

Again, I still suspect Thailand is behind on this issue of PrEP for whatever reason(s).

No, I don't know that for sure, but I don't think you shed much light on this either.

I really would like to understand.

Based on the WHO many infections in the world (and of course Thailand where HIV rates of infection are high in high risk groups) would be prevented with use of PrEP in high risk group people.

If this lack of PrEP for the higher risk population is only about cost savings ... well, treatment of the infected is a lot more expensive.

.......................................................

Don't you think the partner of the infected patients go see doctor too???

They, well, in reality do, not all unfortunately because some of them not being told by the infected partners.

Regarding the government meds,

generic Atripla, which is used for PrEP and costs only over a thousand bath, is not used in the government regimen what so ever! Reason being said too expensive, compared to the local GPOVir family which cost abound 5-600 bath/month, and the national drug committee do not list the meds in any category Of government drug list! So if you have any question you can contact this people and ask them. I am not the one who make a decision what to use what not to use I simply state fact so people know.

As said the meds is not available for public health care what is the point of advertising the options there ? This is killing them doctors inside out knowing there is a better meds but they don't have option to prescribe for their patients being infected or PrEP.

In private section, you pay cash you can access any meds you want so there is always option there. Don't know if there is any campaign normally most of any health campaigns are done by government sectors.

So if you call that 'behind' I would have agreed now.

Edited October 26, 2014 by PMNL

[mommysboy]

It is not like taking a daily baby aspirin. This medicine is powerful. All medicines can have side effects especially taken long term.

I suppose it depends on perceived risk according to type of sex act and gender preference. For my part I think the risk is very very small.

Sent from my i-mobile IQ 1 using Thaivisa Connect Thailand mobile app

[Jingthing]

It is not like taking a daily baby aspirin. This medicine is powerful. All medicines can have side effects especially taken long term.

I suppose it depends on perceived risk according to type of sex act and gender preference. For my part I think the risk is very very small.

Sent from my i-mobile IQ 1 using Thaivisa Connect Thailand mobile app

It is meant ONLY for people who have been identified as very high risk to become infected. Doesn't sound like you.

I may be wrong, but my current impression is that once a day PrEP for MOST PEOPLE if they are medically screened to NOT have major negative side effects especially after the early stages adjustment period.

[Jingthing]

I actually think thailand is not behind on the Pre-exposure recommendation. Most of the ID specialist/ internists are pretty upto date and follow the recommendation from the western HIV a organization regularly. They have seminar and work shop yearly for the thai ID Drs and small seminar at each med school very often. It is a purely money issues here. In private practice, high risk patients are advised on their options. Unfortunately in government setting the drug regimen they use is considered to be 2nd-3rd line drugs, full of side effects so most Drs know better not to poison the healthy individuals with those drugs that's why they do not even bother to tell the patients this option for the time being.

Specialists would mostly be seeing people ALREADY infected, correct?

PrEP is about reaching people NOT YET infected.

A different population.

According to earlier post, it is available here and not particularly expensive. In Bangkok anyway.

What about all over Thailand?

Where is the public information campaign about this option?

Does it exist?

27. TDF 300 mg + FTV 200 mg (Original)

Trade Name: Truvada

Price/Tablet: 70 THB

Price/Bottle: 2,100 THB (30 tab)

28. TDF 300 mg + FTV 200 mg (Generic)

Trade Name: RICOVIR-EM

Price/Tablet: 34 THB

Price/Bottle: 1,020 THB (30 tab)

Government policy?

So government policy is not to pay for Truvada or the Generic?

Why is that?

Is there something wrong with the Generic?

Again, I still suspect Thailand is behind on this issue of PrEP for whatever reason(s).

No, I don't know that for sure, but I don't think you shed much light on this either.

I really would like to understand.

Based on the WHO many infections in the world (and of course Thailand where HIV rates of infection are high in high risk groups) would be prevented with use of PrEP in high risk group people.

If this lack of PrEP for the higher risk population is only about cost savings ... well, treatment of the infected is a lot more expensive.

.......................................................

Don't you think the partner of the infected patients go see doctor too???

They, well, in reality do, not all unfortunately because some of them not being told by the infected partners.

Regarding the government meds,

generic Atripla, which is used for PrEP and costs only over a thousand bath, is not used in the government regimen what so ever! Reason being said too expensive, compared to the local GPOVir family which cost abound 5-600 bath/month, and the national drug committee do not list the meds in any category Of government drug list! So if you have any question you can contact this people and ask them. I am not the one who make a decision what to use what not to use I simply state fact so people know.

As said the meds is not available for public health care what is the point of advertising the options there ? This is killing them doctors inside out knowing there is a better meds but they don't have option to prescribe for their patients being infected or PrEP.

In private section, you pay cash you can access any meds you want so there is always option there. Don't know if there is any campaign normally most of any health campaigns are done by government sectors.

So if you call that 'behind' I would have agreed now.

Well, that's a lot to respond to and I don't pretend to be an expert on where Thailand as a whole is at in respect to PrEP. I do think it probably deserves more attention and consideration here.

As far as the partners question, yes, I see your point about that, but it is hardly only about partners. I am thinking of your typical urban Thai gay male ... you know, probably most of them are not with long term partners ... and yes know the risks with commercial sex workers, but what about the men that just sleep around via saunas, nightclubs, internet apps? Like, get real, most of them. Their risk is really high. Yes we know about condoms. They know about condoms. But PrEP is about adding to the condoms, which of course are not always properly used if at all.

[Jingthing]

As this thread goes on, it's become clear to me to REALLY talk about this issue honestly and in detail it kind of needs to get more into the POLITICS of it. So I'll probably start a thread on the gay forum where I think such a discussion would be a better fit. The health forum is really intended for people to ask about their own health problems. The topic of where PrEP is at in Thailand is much bigger than that.

Thanks for the responses here so far. Not saying to stop posting here exactly either quite yet if you have something on point and medically related to add.

The World Health Organization (WHO) is saying this:

https://www.facebook.com/TheAdvocate/photos/a.10150119304763855.280671.6030918854/10152667504518855/?type=1&theater

Correct me if I'm wrong, but I don't think the health authorities in Thailand are saying the same thing.

I want to know why. I think the hundreds of thousands of high risk Thais, possibly mostly young Thai gay men and transgender people, deserve that answer too.

Edited October 27, 2014 by Jingthing