Pre-exposure prophylaxis in Singapore

Many Singaporeans take the PrEP medication Truvada to prevent HIV infection if they intend to have unprotected penile-vaginal or penile-anal sex or as an additional precaution besides using condoms to prevent HIV infection. Truvada is also prescribed by doctors to individuals at high risk of contracting HIV like sex workers, and the HIV-negative partner in a sero-discordant relationship (which means only one partner is HIV-positive). The drug may also be taken once daily for life.

Original, branded versions of Truvada are available at the larger hospital pharmacies at NUH, SGH or CDC (TTSH) and certain GP clinics like Drs. Tan & Partners and Dr. Chua at Cambridge Clinic. The cost of Truvada at these places is over $900.

Much cheaper generic versions may be obtained through buyers' clubs modelled after Dallas Buyers' Club, as seen in the movie. There are several of these clubs in Singapore. One of them is organised by Rev. Yap Kim Hao of the Free Community Church which has a closeted cell group of HIV-positive churchgoers. A seperate club which supplies generic antiretroviral drugs to people living with HIV is headed by Arthur who may be contacted via his handphone, number 97531592. Arthur sells generics at one of the cheapest prices available. He has been on antiretroviral medication since 2002 and his viral load is undetectable. However, one needs to get a doctor's prescription before he can buy the drugs.

The Ministry of Health and Health Science Authority tacitly allow these buyers clubs to source for generic anti-retroviral medication from overseas and have them shipped to the Action for AIDS (AfA) headquarters along Kelantan Lane, just opposite the Department of STI Control. From these stocks, representatives of the clubs can then procure the drugs for sale to individual buyers.

AfA may be contacted via their hotline: 6254 0212.

Some Singaporeans also travel to Bangkok, Thailand to buy the generics and to be followed up by the STI specialists there once every three months. Many catch a flight on Friday evening and return to Singapore by Sunday night. Places where generic antiretrovirals may be obtained include Bumrungrad Hospital, the Christian Bangkok Hospital and the Thai Red Cross. The latter is colloquially referred to as the "snake farm" or "Sa Pa Ka Chad" in Thai. It is located along Angreedunang Road, at the junction opposite Surawong Road. The Thai Red Cross is reputed to offer the cheapest prices. However, one has to factor in cost of airfare, accommodation, food and local transport.

The generic version of Truvada sold in Bangkok is called Ricovir-em, which was formerly manufactured in India but is now made in Germany. The difference in price per 6 bottles between Truvada and Ricovir-em is over 1000 Baht or about SGD$50.

Caring Pharmacy in Malaysia also stocks antiretroviral drugs.

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=Acknowledgements=

This article was written by Roy Tan.