amfAR’s TREAT Asia program addresses new ways to bolster the HIV prevention response in the Asia-Pacific region
HIV prevention options are expanding. In addition to once-daily oral pre-exposure prophylaxis (PrEP), long-acting injectable options are being rolled out and, if approved, alimatravir, a new investigational oral PrEP medication, would offer a once-monthly option.
“Access to newer HIV prevention options remains uneven within the Asia-Pacific region,” said Dr. Annette Sohn, VP and Director of TREAT Asia. “We are supporting educational resources and guiding rollout strategies for new long-acting prevention options through collaborations with regional partners to address this challenge.”
Giten Khwairakpam, TREAT Asia Program Manager for Community and Policy, noted that “Primary access barriers in the region remain a lack of regulatory applications and the exclusion of a number of countries in programs to accelerate introduction and adoption sponsored by international agencies.”
amfAR spoke with TREAT Asia partners from Indonesia and Malaysia on local efforts to expand PrEP.
Indonesia
UNAIDS estimates that there were 21,000 people newly acquiring HIV in Indonesia in 2025. PrEP-focused HIV prevention efforts are primarily directed toward high-risk populations, including men who have sex with men (MSM), transgender individuals, and female sex workers (FSW). Particular geographic areas of concern include Bali Province, noted Dr. Agus Somia, the head of the HIV clinic and infectious diseases program at Prof. Dr. Ngoerah Hospital in Bali and a TREAT Asia network investigator.
“To date, there are 23 service facilities spread across three regencies in Bali Province that provide free PrEP to key populations,” he added.
Long-acting PrEP has not yet been approved in Indonesia, so oral medications are offered as daily PrEP for FSW and serodiscordant couples and event-driven PrEP for MSM and transgender people. Dr. Somia noted that among those currently access PrEP, most are MSM (65%), followed by FSW (28%), transgender individuals (4.6%), serodiscordant couples (1.4%), and other high-risk groups (1.4%).
“There is a declining trend [among FSW] in PrEP use in 2026 due to adherence factors, side effects, and recent difficulties in outreach,” Dr. Somia said.
“Injectable medication plays a very important role in adherence and effectiveness,” Dr. Somia said when asked about how adopting new PrEP options might overcome barriers.
Malaysia
There were an estimated 2,900 new HIV acquisitions in Malaysia in 2025 and 80% of the ~85,000 people living HIV are men, says Yusralhakim Yusoff, program director of the Malaysian AIDS Council. Adults aged 20–29 represent about 44% of people living with HIV, followed by those aged 30–39 at 31%.
“In Malaysia, the promise of HIV prevention continues to be shaped by the realities faced by young people and key populations, particularly young men who have sex with men, transgender people, sex workers, and people who use drugs,” Yusoff said about the need to identify context-specific issues.
Male-to-male sexual contact is the main driver of HIV acquisition and 68% cases diagnosed in 2023 were detected late. “These figures reinforce the urgency of prevention approaches that are youth-responsive and focused on key populations,” Yussoff said.
“For many individuals at high risk of HIV acquisition, seeking prevention services can still feel socially and legally exposed, reducing health-seeking behavior, delaying testing, and making daily oral PrEP difficult to start and sustain,” he added. “In this context, HIV prevention cannot rely only on biomedical availability; it must also be delivered through community-trusted, confidential, affordable, and non-judgmental services that recognize the lived realities of people most affected.”
Yusoff noted long-acting options reduce some of these barriers, saying they “could lessen the daily pill burden, improve adherence, reduce the frequency of clinic visits, and provide greater privacy for people who may not want PrEP tablets visible at home or work.”
But unless issues like cost and Malaysia’s exclusion from generic licensing agreements are addressed, Yusoff said, the game-changing medication will not reach its full potential.
