Since August 2, 2004, the FDA approved indication of Truvada tablet to prevent or control HIV infection. Made by the Gilead Sciences Factory. Inc. Truvada Tablet is a combination of two different substances, containing emtricitabine and tenofovir. (Emtricitabine is called a nucleoside reverse transcriptase inhibitor, while tenofovir is called a nucleotide reverse transcriptase inhibitor. They are often called NRTIs.) WHO includes a combination of these drugs as essential drugs. This product is approved in the US for people at high risk of HIV infection.
This method of treatment is described in short PrEP: Pre-Exposure Phrophylaxis, or in Indonesian “Pencegahan pra-paparan” is an act of protecting patient before contact with the HIV-1 virus, by taking medication every day and having safe sex.
Truvada is given to patients at high risk of HIV, including those who have HIV-infected partners, have unprotected sex, have multiple sex partners, have infections with sexually transmitted diseases-STDs, or use / abuse drugs or alcohol. The effect will help reduce the amount of HIV in the body so that the immune system can work better and reduce HIV complications (such as new infections, cancer) and improve quality of life.
To whom does the PreP method need to be given? Who is given Truvada? recommendations according to those issued by WHO, are :
- For serodiscordant couples, one partner is infected with HIV and one of them is not.
Then additional HIV prevention drugs are needed. The daily dose of Prep (tenofovir or tenovofir and emtricitarabine) can be considered as an additional intervention for couples who have not been infected with HIV 1.
- The spread of HIV that occurs in men and transgender women who have sex with men. Then additional HIV prevention drugs are needed. The daily dose of Prep (tenofovir or tenovofir and emtricitarabine) can be considered as an additional intervention for couples who have not been infected with HIV.
- For men who have sex with men, Prep is recommended as an HIV prevention.
With the above considerations, it is expected that the benefits that can be taken when consuming Truvada are :
- Helps reduce the amount of HIV in the body so that the immune system can work better.
- Reducing the chances of getting HIV complications (such as new infections, cancer) and improving your quality of life.
The question is whether Truvada needs to be provided in Indonesia?
The answer is sensitive problems, and is closely related to the negative stigma towards HIV that is highlighted by same-sex enthusiasts.
In Indonesia, which has an eastern culture, the stigma of the “sinner” group continues to stick forever. The religious rules clearly prohibit same sex without tolerance. If it is forced there will be clash. But tolerance can still be given to those who are sick and willing to repent, related to emergency law that must be ratified.
Now we should have started to make a social and ethical impact analysis, when thinking about procuring Truvada drugs :
- Drug Provider or Regulator.
Distributing Truvada drugs, public health promotion activities have a thin line between educating and promoting same-sex relationships. Communication, information, and mass education are very complex, and the feedback can vary, but from the viewpoint of society in general, a tagline cut, promotional frames that say that HIV can now be prevented by drugs can be interpreted as supporting same-sex liking behavior.
- Male or transgender drug recipients who have sex with men. This can be good news because those who are vulnerable to HIV can continue to connect with partners who have been infected with HIV without fear of contracting it. This attitude can lead to euphoria among them, then carry out their sexual behavior continuously while in Indonesia this group is certainly opposed.
- Serodiscordant patients. The relationship between husband and wife who have HIV Truvada tablets should be given. To save couples and the possibility of pregnant women whose fetuses are at high risk of infected with HIV.
- Truvada can cause a misinterpretation of condom use. Men / transgender who are have sex with men, or serodiscordant couples may not using condom because there is no HIV transmission, but this actually causes the spread of sexual transmitted disease.
Truvada is phenomenal with the presence of these tablets HIV and Aids can be prevented early, but provision and procurement in Indonesia need to look at various social and ethical considerations concerning the values adopted by the majority of Indonesia’s . Regulators, scholars, professional organizations, NGOs and community leaders must talk together to regulate the distribution of this drug.
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