Background: Formal Pre-Exposure Prophylaxis (PrEP) as a form of biomedical prevention is not available in many countries, while generic PrEP available in Thailand offers low threshold access to this form of HIV prevention. Yet this form of access requires special online-to-offline measures and a counselling procedure that is tailored to the needs of foreign clients and a travelling population.
Description: Pulse Clinic Bangkok implemented an online-to-offline procedure to counsel men-having-sex-with-men (MSM) for PrEP and to provide HIV & STI testing, PrEP provision and regimen advice on location. From January till September 2017, after engaging in online counselling first, 2028 became so-called “PrEP tourists” with visits to the clinic. A total of 1703 (84%) returned for follow up visits after the initial visit. MSM can engage via different social media channels and gay dating apps with the clinic prior to their visit. During these chats knowledge about PrEP is provided. Later visits can be scheduled also outside regular office hours. Special online and offline counselling for substance users and alternative HIV prevention strategies for MSM who later (have/want to) stop using PrEP are offered. Clients are empowered and furnished with the knowledge to arrange HIV testing and continuous medical follow-up in their home countries.
Lessons learned: There is a large number of so-called “PrEP tourists” who regularly procure PrEP in Thailand and make use of local medical service provision. While continuously procuring PrEP via Bangkok, HIV testing and continuous medical follow up is also executed with local health care providers in their home countries. Overall, this mode of provision allows PrEP access for vulnerable MSM populations who cannot access PrEP at home. Yet at the same time, due to split health care provision, potential sero-conversions cannot always be traced.
Conclusions/Next steps: Affordable PrEP can contribute to a successful individual HIV prevention strategy even for MSM who cannot access PrEP formally in their home countries (e.g. due to lack of availability, high costs or stigmatizing health services). The model applied here comes with high counselling demands for medical service providers, and demands a high level of independent, responsible individual health care management by the PrEP users themselves.