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PrEP implementation Malaysia
PrEP Implementation in Malaysia: Lessons Learned and the Way Forward

Released: August 18, 2025

Iskandar Azwa
Iskandar Azwa, MD
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Key Takeaways
  • A community-driven approach and integration with primary care was central to successful pre-exposure prophylaxis (PrEP) implementation in Malaysia.
  • Societal and institutional stigma remains a barrier to PrEP, but digital tools and demedicalization of PrEP can help expand access and reduce bias.

When Malaysia first introduced pre-exposure prophylaxis (PrEP) as part of its HIV prevention strategy, the road ahead looked somewhat uncertain. Could a Muslim-majority country with conservative social norms and substantial legal barriers around same-sex sexual activity and expression of transgender identity successfully navigate HIV prevention policies and roll out PrEP? Fast forward to today: The answer is a cautious but confident yes!

Although challenges persist, Malaysia has become a regional example of how a community-driven approach and an integrated primary care service delivery model with universal healthcare coverage can scale up PrEP.

From Pilot to Policy
Although the initial focus of PrEP service delivery was in the private sector, this rollout was slow and limited to informal uptake in key population-friendly clinics in major cities.

The Malaysian Society for HIV Medicine introduced the country’s first National PrEP Guidelines in 2016.

In 2018 a pilot program supported by international donors was introduced: the My PrEP study. It assessed the feasibility of PrEP implementation in the public sector and in partnership with community-based organizations. These early efforts helped identify the importance of centering communities in PrEP service–delivery models that also provide integrated primary care.

Although community-based organization–led models were promising, there were country-specific challenges. These included lack of recognition of community health workers as potential PrEP providers, difficulties with certification to prescribe PrEP, and demedicalization of PrEP—that is, shifting PrEP provision outside of traditional clinic settings to expand access. 

In conjunction with Malaysian AIDS Foundation, the Malaysian Society for HIV Medicine launched the HIV Connect program in 2020, a self-paced online module for PrEP and postexposure prophylaxis certification. It was developed by leading infectious disease specialists aimed at upscaling PrEP prescribing by primary care providers, especially in private clinics.

To facilitate PrEP access, researchers from the Center of Excellence for Research in AIDS & Infectious Diseases, University Malaya in Kuala Lumpur, developed My PrEP Locator, mypreplocator.com. It is a comprehensive online directory of public and private PrEP prescribers with an interactive map. This directory was designed to enable individuals seeking PrEP to easily find nearby PrEP-prescribing healthcare professionals (HCPs).

Despite these concerted efforts to increase PrEP uptake, PrEP prescribing was primarily off-label up to this stage. It was not until 2022 that oral tenofovir disoproxil fumarate/emtricitabine was approved by the National Pharmaceutical Regulatory Agency for HIV prevention, thereby enabling wider clinical adoption, particularly in the public sector.   

Community–Clinic Partnership
The Malaysian Ministry of Health began introducing PrEP in primary care clinics in the public sector during 2023. The PrEP service delivery model was fully integrated into key population-friendly primary healthcare clinics linked to a network of PrEP navigators. These PrEP navigators were clinic-based community healthcare workers who facilitated access for potential PrEP users. Communities played a central role in generating demand for PrEP, developed peer-led outreach programs, facilitated risk assessments, created referral pathways, and pioneered PrEP advocacy.

So far this community–clinic partnership model has proved effective at engaging populations at increased risk of HIV infection, many of whom avoid public healthcare because of stigma. At 12 months, 87% accessing PrEP were men who have sex with men, with a retention rate of 87.5%. 

Addressing PrEP Stigma
Despite broader acceptance of PrEP in policy, stigma remains a significant barrier within healthcare settings. When PrEP was initially rolled out by the Ministry of Health, religious leaders, academics, and even some HCPs objected because of concerns that it would encourage condomless sex and risk compensation.

However, justifying PrEP on the grounds that it prevents harm and reframing it as a biochemical tool to reduce HIV in the interest of public health helped divert the narrative away from PrEP as a moralistic issue. However, ongoing antistigma training and sensitization is essential to reduce biases and improve cultural competence. Provision of nonjudgmental care and creation of safe spaces in the clinic with representation and visibility of key populations is a crucial part of PrEP provision. 

Digital Platforms Supporting Clinical Access
 For PrEP candidates who cannot visit the clinic (because of stigma or other barriers), mobile health interventions can help. Mobile health interventions such as the JomPrEP app provide a clinic-integrated platform to deliver holistic HIV prevention services from risk assessments, ordering HIV self-test kits, appointment scheduling, online consultations, and mental health support. They have the potential to offer more discretion, improve access, and encourage engagement, particularly for younger men who have sex with men and those who prefer digital interaction over traditional clinic visits.

These mobile health interventions in Malaysia demonstrate that digital tools can effectively complement, but not replace, human interaction. There still remains a great need for human-centered, stigma-free interactions.  

Pharmacy-Led PrEP
Finally, I believe that pharmacy-led PrEP is a promising service delivery model and must be scaled up. In this model, trained community pharmacists to conduct risk assessments through a digitalized assessment tool, with HIV screening done using an HIV self-test kit and HCP oversight provided through a telemedicine platform.

However, there is still a need for targeted recruitment strategies to reach key populations beyond men who have sex with men, and to ensure that HCP support is available during extended pharmacy hours. In the future, this delivery model could be expanded beyond PrEP to include postexposure prophylaxis, sexually transmitted infections, and hepatitis B and C. 

The Malaysian experience taught us that community collaboration is essential and that stigma needs to be addressed both structurally and interpersonally, from policy to practice. There is a need to expand PrEP providers beyond HCPs, and PrEP needs to be demedicalized. Ultimately, as we continue to scale up PrEP, we must maintain focus on equity and dignity in care delivery to be successful.

Your Thoughts
How can you apply the lessons learned through PrEP implementation in Malaysia to provision of PrEP in your own practice? Leave a comment to join the discussion!

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