PrEPing the vulnerable – Sri Lanka to roll out PrEP pilot under the new NSP

by Roshan DeSilva, Sri Lanka

Tenofovir disoproxil and emtricitabine: common combinations for PrEP

The effectiveness of Pre-Exposure Prophylaxis (PrEP) has been proven in number of research studies around the world. The significant role that PrEP can play in preventing new infections among gay, bisexual men and other men who have sex with men (MSM) and transgender people will indispensably contribute to reaching 90-90-90 targets. Despite the proven effectiveness of PrEP, rolling out PrEP programs for key populations remains a challenge in Asia and the Pacific due to number of reasons, such as financing of the drug by the national governments as part of the national HIV prevention programs, stigma and discrimination attached to PrEP, and the myths that contradict available research findings on the effectiveness of the drug.

The discourse on rolling out PrEP for key populations in Sri Lanka has been gradually picking up momentum since the PrEPARING Asia Consultation organized by APCOM in 2015. However, a larger conversation on PrEP between the National STD/AIDS Control Program (NSACP) and the communities did not take place until the latter part of 2017. The National HIV Strategic Plan (NSP) for the period 2013- 2017 underwent an end-term review process to inform the development of the new NSP for the period of 2018- 2022. Key population organizations independently engaged in a parallel review process led by the communities themselves and developed a list of recommendations for the new NSP where communities officially declared the demand for PrEP for key populations.

This recommendation on PrEP was initially challenged by a number of key partners in the national Global Fund program based on procurement of the drug, lack of data on the effectiveness of drug in South Asian contexts, and the alleged increase of risky sexual behavior among PrEP users. During a meeting held between the communities and NSACP, prior to the development of the final draft of the NSAP 2018–2022, the discussion on PrEP recommendation went through a heated argument, which was finally resolved with the inclusion of a PrEP rollout program into the new NSP during the next five years to assess the feasibility of integrating PrEP in to the HIV prevention package in Sri Lanka.

The commitment that the communities have been able to gain from the NSACP to consider PrEP rollout for key populations and to implement a PrEP rollout program to assess the feasibility will be a significant milestone in the HIV response of the country. The national HIV prevention target in the country set by the NSACP is to end all new HIV infections by 2025, an ambitious target that goes beyond the already ambitious global targets by 2030. Therefore, the role of PrEP in reaching this new target in terms of averting new HIV infections among key populations is indispensable. As Sri Lanka is considered a low prevalence country, the use of PrEP among key populations will contribute to maintain the low prevalence of the country.