Pre-exposure prophylaxis in Singapore

Truvada is an antiretroviral drug combination of tenofovir and emtricitabine which has been shown to be 60-70% and sometimes up to 96% effective in preventing the transmission of HIV in gay men and other high-risk groups like sex workers, transgender women, intravenous drug users and HIV-negative partners in sero-discordant relationships. It was been introduced in parts of Asia in the mid-2010s. While oral pre-exposure prophylaxis or PrEP is starting to transform HIV prevention in the United States, it has yet to be fully integrated into Asian programmes. Representatives from national AIDS programmes, health service providers and community groups from 18 Asian countries are currently exploring how to roll out PrEP in the region.

Many Singaporeans take Truvada to prevent HIV infection if they intend to have unprotected penile-vaginal or penile-anal sex or as an extra precaution in addtition to using condoms. Truvada is also prescribed by doctors to individuals belonging to the high-risk groups mentioned above. The drug may 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 have been available at certain GP clinics like the 6 branches of Drs. Tan & Partners (Dr Tan & Partners, Dr Tan and Partners Bencoolen, Dr Tan & Partners at Scotts, Dr Tan and Partners Katong, Dr Tan and Partners Novena, Dr Tan and Partners Somerset) since 2014 and Dr. Chua at Cambridge Clinic. The cost of Truvada at these places is $900 for one month's supply, before GST.

Much cheaper generic versions (around 1/4 the price of the branded original) 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 - one month's supply of generic Truvada costs $70, as compared to over $900 for the branded version sold at clinics. He disclosed the fact on Blowing Wind, a forum accessible to anyone in the world even without registration, that he has been on antiretroviral medication since 2002 and that his viral load is undetectable. It is to give people living with HIV hope that one can lead a normal life with antiretroviral therapy. However, one needs to show him a doctor's prescription before one can buy the drugs. The price of one pill of Truvada in Singapore Dollars is about $55 in the UK, $50 in the USA, $35 in Canada, and $30 in Singapore. The cost of the generic version in Thailand is $1.

The Ministry of Health and Health Sciences 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 (DSC). 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 AIDS Research Center. 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 the cost of airfare, accommodation, food and local transport. Another physician which also prescibes and sells generic antiretrovirals is Dr. Natthakhet of Sathorn International Clinic, tel/fax: +66 (0) 20093877, e-mail: sic56216@hotmail.com. He used to work at the Thai Red Cross. Opening hours are 1700 to 2000hrs on weekdays and 0800 to around 1800 or 1900hrs on weekends. Many Singaporeans who are wary of the large crowds at the Thai Red Cross consult him.

The generic version of Truvada sold in Bangkok goes by the name of Ricovir-EM, which was formerly manufactured in India but is now made in Germany. The difference in price per tablet between Truvada and Ricovir-EM is over 1000 Baht or about SGD$50.

Caring Pharmacy in Malaysia also stocks antiretroviral drugs. Dr. Singaraveloo of Johor Specilaist Hospital, 39 B Jalan Abdul Samad, tel: 02-07 225 3000 ext. 4854 is a physician who sees HIV-related problems.

On 29 November 2016, it was reported in TODAY newspaper that Truvada would also be offered by Tan Tock Seng Hospital (TTSH) which sees more than one in two people with HIV. Two other establishments — DSC Clinic at Kelantan Lane and National University Hospital — also planned to offer PrEP. TTSH decided to offer PrEP early in 2016 and hospital staff had been putting procedures in place to provide the service in a systematic and comprehensive manner. By November 2016, the hospital had prescribed PrEP to one patient, a middle-aged man who found out about the service through word-of-mouth. TTSH was in the midst of revising the cost of the medication. TTSH senior medical social worker Amanda Yap said the introduction of PrEP allowed the hospital to play a powerful preventative role, reaching out to people at risk. Dr. Tan Kok Kuan of Drs. Tan & Partners said an original Truvada pill for PrEP cost about S$30 each, with other costs involved for consultation and various tests.

=See also=


 * Pre-exposure prophylaxis
 * Post-exposure prophylaxis
 * Post-exposure prophylaxis for HIV infection in Singapore
 * Importing/bringing antiretroviral drugs into Singapore

=References=


 * Blowing Wind discussion on the cost of HIV medication in Singapore:.

=Acknowledgements=

This article was written by Roy Tan.