A landmark symposium at the 25th International AIDS Conference on July 25, organised by the Malaysian AIDS Foundation (MAF), the Malaysian AIDS Council (MAC), and Sunway Group, showcased Malaysia’s noteworthy strides in HIV prevention, reported by Codeblue. With a focus on pre-exposure prophylaxis (PrEP) and innovative financing models, this event attracted significant attention from health professionals and advocates alike.
Prof Dr Adeeba Kamarulzaman, chair of MAF, led the discussions, shining a spotlight on Malaysia’s advancements in HIV prevention strategies. Among the prominent speakers was Dr Anita Suleiman, president of the College of Public Health Medicine and former director of the Disease Control Division at the Ministry of Health (MOH). Renowned as the architect behind Malaysia’s PrEP programme, Dr Anita delivered an insightful presentation titled “Harmonising Health and Belief: PrEP Journey in Malaysia.” She elaborated on how PrEP aligns with Islamic principles, offering a roadmap for its integration into primary healthcare services by 2025.
Dr Anita articulated several Islamic ethical principles that endorse PrEP. The preservation of life (hifz al-nafs) is a fundamental tenet, with PrEP serving as a safeguard against HIV infection. This aligns with the primary goal of protecting individuals from life-threatening diseases. The principle of preventing harm (darar) sees PrEP as a valuable tool to mitigate the significant consequences associated with HIV. Furthermore, seeking medical treatment (tadawi) encompasses PrEP as a preventive measure, reinforcing the broader context of health-seeking behaviour. Ethical resource allocation (adl) ensures that PrEP remains accessible to high-risk populations, promoting justice within public health frameworks.
Highlighting the importance of informed consent and individual autonomy, Dr Anita stressed the necessity for healthcare providers to ensure that patients are fully aware of their options regarding PrEP. Engaging with religious and community leaders, along with employing culturally sensitive communication strategies, is paramount for promoting acceptance and understanding of PrEP within various communities.
The roadmap for PrEP’s integration has been formalised within the National Strategic Plan for Ending AIDS 2016-2030, developed by the MOH. This comprehensive plan emerged from regional consultations and national surveys, coupled with price reductions for generic tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) and multisite PrEP demonstration projects. By 2023, the National Pharmaceutical Regulatory Agency (NPRA) had approved new oral PrEP options and broadened service availability in government health clinics.
Dr Anita noted that Malaysia’s approach draws from successful strategies in countries such as Australia, Brazil, Kenya, Zambia, and Thailand. These countries have emphasised early adoption and government backing, community engagement, targeted initiatives, and thorough monitoring and evaluation.
Complementing her presentation, Dr Mazliza Ramly, principal assistant director at MOH’s Disease Control Division, introduced the “PrEPGov” project. This initiative aims to dismantle barriers to accessing PrEP through community engagement and integration into primary healthcare. The establishment of a PrEP Navigator Network will assist individuals in managing their usage while sensitising healthcare providers to diminish stigma surrounding key populations.
Dr Mazliza reported promising outcomes from Malaysia’s PrEP programme, highlighting low rates of HIV seroconversion and effective collaboration within communities. Initial findings indicate high retention rates, positive behavioural shifts, and increased HIV screening—key indicators of the programme’s success.
Dr Raja Iskandar Shah Raja Azwa, President of MAC and Associate Professor of Infectious Disease at Universiti Malaya, along with Yan Nee Gan, an implementation science researcher from Universiti Malaya, presented research on alternative modalities for delivering PrEP. Dr Raja Iskandar’s presentation on JOM-PrEP underscored the innovative application of mHealth technologies to extend PrEP access beyond traditional clinical environments.
Collaborating with researchers from the University of Connecticut and Yale, the JOM-PrEP app was adapted to fit Malaysia’s health context from a pre-existing HealthMindr app. This integrated platform provides comprehensive HIV prevention services including HIV testing via self-test kits, PrEP services encompassing risk assessments and e-consultations, mental health support, and substance use services.
During beta testing over 30 days, user engagement was notably high among 50 men in Greater Kuala Lumpur. An impressive 84 per cent ordered an HIV self-testing kit through the app; 92 per cent used it to initiate PrEP—many opting for same-day commencement. The app also facilitated mental health screenings; 89 per cent of those assessed for depression exhibited moderate-to-severe symptoms and received referrals for mental health support.
Future phases will involve a randomised controlled trial aimed at evaluating the app’s effectiveness in enhancing HIV testing and PrEP uptake compared to standard treatment protocols. This study will apply the Consolidated Framework for Implementation Research to investigate practical aspects influencing adoption and scaling within real-world settings. It will also tackle challenges related to mHealth implementation such as privacy concerns, data security issues, platform compatibility, and network access—underscoring the necessity for robust research methodologies.
The JOM-PrEP app exemplifies how tailored mHealth solutions can address barriers to accessing PrEP while improving HIV prevention services in Malaysia. Concurrently, Yan presented research focusing on a pharmacy-led model for PrEP service delivery designed to boost access and uptake in the Klang Valley.
This model capitalises on the accessibility of community pharmacies and the expertise of trained pharmacists—often the first point of contact for health advice. By incorporating HIV self-test kits available at pharmacies, this approach simplifies the initiation and continuation of PrEP services outside traditional clinical settings. Conducted across six private community pharmacies in Klang Valley, the study captured real-world implementation data, including participants’ out-of-pocket expenses for medication and lab tests.
Pharmacists collaborated with physicians through telemedicine platforms to facilitate same-day prescriptions for PrEP. Preliminary findings indicated high levels of acceptability and feasibility, with impressive initiation and retention rates among participants. Many expressed satisfaction with the service and willingness to recommend it to others. Community pharmacies emerged as reliable sources for information, testing, and medication counselling—serving as convenient locations for delivering essential HIV prevention services.
The panel discussion at the conference sparked interest both regionally and internationally regarding scaling up the pharmacy-led model in Malaysia. This marks a pivotal moment in efforts to enhance HIV prevention access in line with Malaysia’s objective of ending AIDS by 2030.
Several recommendations emerged from these discussions aimed at improving PrEP uptake and effectiveness. Enhanced integration of PrEP into national HIV strategies was deemed crucial. Establishing a supportive legal framework alongside increased funding through government and international partnerships emerged as vital steps forward. Strengthening healthcare infrastructure—including mobile and community clinics—and implementing rigorous monitoring systems were also emphasised.
Respecting cultural and religious norms while ensuring confidentiality is essential to promote PrEP as a key instrument in tackling HIV. Collaborative efforts among stakeholders will be instrumental in safeguarding vulnerable populations while enhancing public health outcomes.
The symposium raised awareness regarding sustaining HIV/AIDS programmes amid shifting healthcare priorities post-pandemic. With resources being redirected elsewhere, robust financial strategies for HIV/AIDS remain essential. The partnership between MAF, the Malaysian government, and Sunway Group was highlighted as a strong example of sustaining these efforts.
Nik Tasha Nik Kamaruddin, chief brand strategy officer at Sunway Group, detailed Malaysia’s funding landscape for HIV initiatives. It comprises domestic public funding alongside significant contributions from private sector entities and international organisations. The National Strategic Plan allocates 75 per cent of total funding towards treatment and support programmes.
Yet challenges persist; data reveals that 45 per cent of people living with HIV (PLHIV) in Malaysia lack access to necessary medications. Addressing these gaps is imperative. Sunway Group has initiated projects like the Sunway HOPE Borneo Programme aimed at providing cash incentives to low-income patients with HIV. This initiative assists with travel costs for hospital appointments for Malaysians living in Borneo whose household income is RM2,000 or below.
The HOPE programme has positively impacted over 600 beneficiaries by connecting rural patients with advanced healthcare services while addressing poverty-related barriers. Sunway has also incorporated food aid initiatives supporting around 800 beneficiaries into this programme.
The Teratak Kasih Tok Nan Sarawak initiative offers healthcare access along with transportation assistance for underprivileged individuals suffering from chronic ailments including HIV. This initiative has enrolled 138 beneficiaries—many identifying as PLHIV.
These efforts have fostered significant improvements such as better adherence to treatment among PLHIV while enhancing food security throughout East Malaysia. The United Nations Sustainable Development Goals (SDG) 2023 report stresses that increasing investment through evidence-based approaches is vital for ending AIDS.
Corporate social responsibility (CSR) plays an important role in this context by facilitating partnerships among private sectors, NGOs, and government entities striving towards eradicating AIDS in Malaysia. Initiatives instil hope within beneficiaries—encouraging adherence to treatment while uplifting overall quality of life.
Corporate funding provides crucial support addressing existing gaps in resources required for effective HIV/AIDS treatment delivery. This NGO-corporate-government model exemplifies SDG Goal 17: Partnership for the Goals—a successful multi-sector collaboration that holds potential for replication across Asia and Southeast Asia.
The discussions at this symposium not only illuminated current strategies but also set a course for future efforts aimed at improving health outcomes for those affected by HIV in Malaysia.
