Acceptability of PreP in Cambodia in 2024

An unprecedented study on key populations that are particularly vulnerable to HIV

Published on 24 May 2024

The essential

For the first time in Cambodia, a study has been carried out to assess the acceptability of pre-exposure prophylaxis (PrEP) and preferences for administration in key populations that are particularly vulnerable to HIV. The results show that, despite the controversy that has existed since 2004, the use of PrEP under certain conditions could be a major step forward in the fight against HIV.

The context

While Cambodia has almost achieved the UNAIDS goals of helping to end the AIDS epidemic in the general population, the prevalence of the disease is still very high among key populations. For example, it is 9.6% in transgender women, compared with 0.5% in the general population. Pre-exposure prophylaxis (PrEP) could be very beneficial. Approved in Cambodia in 2019, its use is controversial, however, following the interruption of a clinical trial in the country in 2004 for ethical reasons (community organisations of sex workers considered that the population was being exploited by pharmaceutical companies and developed countries).

The aim of the study and its methodology

Camilla Oliveri and her co-authors have published in AIDS Care the results of a study funded by ANRS MIE into the perception of PrEP in Cambodia.

The study was conducted in 2022 in Phnom Penh with the aim of assessing the acceptability and preference for the type of PreP administration among key populations (transgender women, men who have sex with men (MSM), male and female sex workers). The qualitative, community-based approach involved six focus groups (59 participants) and four semi-structured individual interviews on the following topics:

  • Perception of HIV risk
  • Experience with medical facilities and community organisations
  • Perception and satisfaction with available HIV prevention strategies (condoms)
  • Expectations and needs regarding innovative HIV prevention strategies (oral and injectable PrEP)
  • Beliefs and representations about PrEP and its perceived efficiency

Results of the study

Overall, key populations have a positive perception of PrEP. Their preference is for daily, community-based PrEP rather than event-driven, hospital-based PrEP. If it became available in Cambodia, injectable PrEP would be a potential option.

In detail, promiscuity, alcohol consumption and non-use of condoms are seen as risk factors for HIV infection. People think that oral PrEP is a good alternative to condoms, providing effective protection against HIV and guaranteeing access to free health check-ups. On the other hand, the perceived drawbacks to PrEP include the absence of protection towards other sexually transmitted infections, fear of side-effects and difficulties of adherence.

“We recommend proposing different PrEP regimens and PrEP delivery-models to broaden PrEP acceptability and adherence in Cambodia, increasing the number of community-based organisations and improving the services they offer, rolling out injectable PrEP when it becomes officially available, and improving information on PrEP side effects.” (Camilla Oliveri, Aix-Marseille University).

Conclusion

Results of this study show that the diversity of methods of administration and healthcare settings could promote PrEP acceptability and adherence in Cambodia, thereby enabling an effective fight against HIV.

 

Bibliography

Oliveri C. et al. “AIDSImpact Special Issue” – High PrEP acceptability and need for tailored implementation in Cambodian key populations: results from a qualitative assessment. AIDS Care 2024; 1–8.