Ep.193 ยา PrEP คืออะไร?

The term "prep" comes from exposure prophylaxis. It means taking medication to prevent a specific disease. However, it cannot prevent other communicable diseases besides HIV.

"What's walking by is a Togainus, Khun Fluke. I'm back again, for about the 300th time. I went out to travel [__]. Luckily, I found a guy, but I couldn't eat in time. But [__] I've already been to MK. Oh, can I take it retroactively? I want to record this now. Maybe you can't see the atmosphere much yet, but I'll collect photos for you to see. So, >> I'm lying here. >> Uh, let's look at the fat one, look at the fat one, the fat one is sleeping, sleeping. >> This is news from Canada. In Thailand, you might not hear it often. When there are people who, oh, euthanasia. >> Euthanasia. >> Euthanasia. Before this tape, it was, it was medication that people took. Avatar, this is it, professor. Because it can prevent. >> Sorry, a person walked by. I saw people walking by. I want to eat diamonds now. Hello, welcome to Pavin Channel. I'm standing in the middle of a botanical garden. Actually, I'll walk back a bit to show the beautiful red bridge. I'm at Fushimi Inari Shrine. I'm still stuck in a loop of visiting landmarks in Kyoto because Khun Fluke is still here. Fluke, come in. >> Alright, let's continue with clip 2. >> It's like talking about medicine and health. >> We promised our viewers in the last clip that after the Olympics, we would talk about >> another big medicine, one that is being talked about. >> Which is a medicine that Khun Fluke takes 5 pills a day. >> What is this medicine called? It's called PrEP, professor. It's one of the experts. >> Oh. >> The medicine is called PrEP. >> Yes. >> PrEP comes from exposure prophylaxis. So, it means taking medication to prevent a disease. >> A specific disease. And actually, this medicine should not be limited to the LGBTQ+ group. >> Yes, yes. In fact, it's used in many groups. But when we talk about PrEP, most of the time, using medication to prevent infection is not just about HIV. There are other things too. There's malaria prevention medication, for example, before going to an area. But the medication used in the past 5-10 years has had a significant impact on preventing HIV infection. >> So, it was confirmed as PrEP. Now, there might be some perception that when talking about PrEP, most people think of the LGBTQ+ community. >> Which is not wrong. >> Yes, because there was a time. >> But it's a bit narrow. >> Because nowadays, being sick is not just limited to LGBTQ+ people. And normal people don't get it. In my understanding, Khun Fluke, PrEP is a medicine that prevents HIV infection. >> Yes, it prevents infection, professor. >> Ah, from HIV. But let me rephrase. I might be wrong, and you can correct me later. It's more than 90% effective, even more, if the correct dosage is used. >> If the correct dosage is used, taken every day, one pill. >> Ah, but it cannot prevent other communicable diseases besides HIV. >> Correct. Gonorrhea, chlamydia, warts, and so on. There are many things, professor. >> I want to create the perception that taking this medicine makes you invincible. >> It doesn't make you immune to any sexually transmitted diseases. Oh, professor. Alright, this is an introduction. Fluke will explain it again. Don't play around. But before that, I haven't even talked about the location yet. >> You, walking down here, wait a moment. And then we will walk past. >> But let's talk about PrEP in the temple. Professor. >> This is very realistic. Very raw reality. What's walking by is a Togainus, Khun Fluke. I'm back again, for about the 300th time. Today, I brought Fluke. This morning, we went to Kinkakuji. >> Ikkyu-san Temple. >> Today, we've returned to, how should I say it, we're still in the city, but in another corner, which is Fushimi Inari Shrine, as we >> Is it a temple with fox deities, professor? >> Correct. >> Will the fox follow us home? >> Bite us. >> Tonight, tonight, the fox will eat our heads. >> Actually, in Pavin's clips, Khun Fluke and I have recorded at this temple many times. The last time I recorded with Nong Pond, we were around here too. But we'll try to be discreet because we might need to be careful when recording in public places like this. In Japan, in places like this, Japan dislikes anything that is over the top. One thing they believe is over the top is using selfie sticks. >> Oh. >> Which is considered ugly, it obstructs. >> If one person uses it, it might not be too bad. If 10 people use it at the same time, it might cause us to use it now. We're using it, right? So, we want to walk away and talk comfortably. In a way, we've come to a point where we can walk and talk. In the first part, I'll do an intro and go back to PrEP because we don't have anything else to talk about regarding Fushimi Inari. We've talked about it before. Fluke, where did it originate? >> Actually, the person who researched this was about 20 years ago. People with HIV mostly took antiretroviral drugs, meaning they got sick and then took them. >> There was no concept of prevention. Uh, no. No. Until a researcher, a doctor in Vancouver, your country, researched and found that if people took the medication every day, one pill. >> Then the chance of infection in high-risk populations decreased by almost 90%. >> That's the origin of the idea. >> Of producing PrEP. >> Yes, but before, PrEP was medication that people took. Avatar, professor. But when they took this latest medication and gave it to the general population, and it worked because it could prevent. >> Sorry, I turned around and saw people walking by. I want to eat PrEP now. >> Apologies to the viewers. >> And then they started prescribing it, and it was found to help the population. Actually, when the study was published, other countries that could access the medication started prescribing it. In Thailand, there are clinics that recommend it, I've heard. >> My generation, even though I'm old, Fluke, my generation might have been too young during the HIV epidemic. Because it started in the 1980s. Yes. And it peaked greatly, actually, from the latter half of the 80s, around the early 1990s. >> Yes, I went through that, but I was very young. It caused a lot of fear. >> When we talk about HIV, people in Thailand might not understand it well. But when we talk about AIDS, it's something that's taboo. It became the number one stigma. Believe me, I grew up with that perception. >> Until now, I don't know if you think one day there will be a miracle. >> That >> In the production of medicine that you can prevent. >> We have almost 9 or almost 90%. It gives me goosebumps. But we won't go there. Fluke, I mean, right now, it's said that there's even medicine to cure AIDS. >> Uh, but right now, it's like >> Uh, the cure is not much yet, but there's an injectable medicine for prevention. >> Uh, but alright, professor. >> But shall we talk about the temple with the fountain, professor? Ah, let's not skip that. Let's not skip it. It's outside the scope of PrEP. We won't skip to talking about people who are already infected and being treated. We're still talking about prevention. >> Ah, it happened in Vancouver. And after that, there was production, research came out, and it became widespread. >> Yes, yes. Because it's just existing medication, and doctors prescribe it to people who don't have it to take to prevent it. But the high-risk group is not just LGBTQ+. There are people who use drugs, or who use needles, for example. >> Uh, it can be transmitted. So, it's considered safe, let's say. >> Two points. The first point is the process of getting the medication. What is the process? You can't just walk up to the counter and ask for PrEP. >> It's not like paracetamol, where you walk in and buy it. >> Tell me the process. >> You have to do a blood test. You have to test your blood first to make sure you don't have it. Because if you have it, the medication will be too weak and won't protect you. >> So, you have to make sure you don't have HIV first. That's number one. And number two and three is to check your liver and kidney function. >> Make sure your liver and kidney function are normal first. >> Uh. >> Because the medication, the chance of it causing, like, increased deterioration of the kidneys or liver, is there a chance? It's a small chance, but you have to monitor it. >> Most doctors do a baseline test and then monitor kidney function regularly. >> Ah, so you have to consult with your doctor first, a GP, or whoever. >> Regularly, yes. If the doctor is going to prescribe it, you might have to talk to them every 3 months, usually around 3 months. >> But there's also a process of blood testing every time. >> Yes, yes. You have to follow up to see if, because taking the medication, the doctor prescribes it daily, but some people forget to take it or whatever. And then something happens. There's still a chance because it's 90%, not 100%. >> For example, if we are in Canada and want to get PrEP, wait a moment. In the case of Canada, getting PrEP is free, covered by the government. >> Ah, ah. Especially if you are a resident or a PR. >> This is definitely covered. >> But again, even after all the tests, it's not like you can just go back and forth. If I remember correctly, you have to go back every 3 months, and you have to have blood tests every 3 months. >> Every 3 months, yes. So, you have to get tested regularly. If you don't get tested, most doctors won't prescribe the medication. It's normal for the system. >> Okay, one more thing. Normally, if people have regular sex, let's use the word "regularly." >> Uh. >> Frequently, meaning taking one pill a day. >> One pill a day, yes. >> One pill, one pill, keep taking it, keep taking it. But there's a case like this. >> Oh, you, I'm old. >> You, okay. They call it on-demand. I can't have sex every day. I have to fight political battles. Where will I find the time? >> Where? I have to help people. >> I have to sacrifice my life to help the younger ones, write certificates, I don't know. Okay, but seriously, if it's on-demand. >> Which is possible. >> Possible, possible. But the effectiveness, meaning the success rate, is it as good as taking it every day? Maybe not as good, but close. >> For example, I'm going to travel abroad. >> And I know that during this trip, I will have. >> We don't know what will happen. We want to be safe. >> Uh, okay. Let's say I'm going for 2 weeks. And I've planned it, Fluke. For these 2 weeks, I'll be having sex every day. >> Next week. >> Having sex every day, but not how many times a day. >> Uh, the medicine, is it? One pill is one pill. We don't count how many times we have sex. But I'm saying, let's say I'm traveling for a week. >> Uh. >> When should I start taking the medication? Of course, what I know for sure is that when I'm there, I have to take it every day. >> Every day, yes. >> But how do I start and finish? Tell me. >> Yes, yes. If it's on-demand, you might have to start with 2 pills first, and then 24 hours before. >> Before traveling, before having sex. Let's say I'm going to have sex on Monday. >> I should take it on Sunday. >> Sunday morning, 2 pills. >> And then on Monday, it's 1 pill, 1 pill. Tuesday, 1 pill. Okay. Let's say this Friday is the last day. And I think I won't have any more. On Friday, take 1 pill. >> Take 2 days after the last time. >> Ah, the last time was Friday. >> Friday, take Saturday, Sunday. Safe. >> One pill a day, and finish on Sunday. >> Uh. >> If we are sure that we won't have sex after that. Meaning, risky sex. >> Yes, correct. So, this is how it works. It's 2 + 1 + 1. >> Uh, 2 + 1 + 1. >> 21. >> Uh, 211. >> Ah, this is on-demand. Yes, yes. >> Here's another one. >> My lust doesn't discriminate. I have PrEP. >> But I haven't taken it yet. I left it at the hotel. >> Uh. >> And I went out to travel [__]. Luckily, I found a guy. >> I couldn't eat in time. [__] I've already been to MK. >> Can I take it retroactively? >> Retroactively? There's no study to support it. There is, but it's a different method. The formula will be a bit different. Professor. >> This has to be a doctor's case. The doctor has to look at it and then prescribe it. >> Let's say I had sex at 3 PM. >> And I didn't take any PrEP beforehand. I got back to the hotel at 7 PM and took it. >> Too late. >> If that person has HIV. >> There's another point. If they have HIV but take medication every day until they are undetectable. So, that person is not a carrier. >> Uh, if they are undetectable, it's fine. >> Ah, if they are not a carrier, then they are not a carrier. So, it's fine. But in the real world, Fluke, you don't know. >> Yes. >> Who your partner is. >> They probably won't tell us. >> Yes. >> Some people, if they tell us, it's good. It's our luck. >> Some people tell us, but we don't know if they're telling the truth or lying. But in my opinion, if someone is HIV undetectable. >> I don't need to tell me. >> Exactly. That's my point. If they tell me, I'll believe them 90%. >> Oh. >> Meaning they don't need to tell me at all. Or they can lie to my face and say I don't have it. >> What if it can't be transmitted? >> Correct, correct. For me, they have no reason to tell me that they have HIV and are undetectable. Or to lie. It doesn't make sense to me. I might be naive in that regard. Because some people might interpret it more deeply. If I say this, it makes them trust me more. Because I care about them. So, for me, I see people with undetectable HIV as not a stigma at all. >> Right? They are normal people like us. Normal. Like us. And that's it. But we don't want to talk about this. So, let's go back to the last point before we end this. So, how late is too late? >> It's not too late. Professor. If the medication taken for PrEP, if we have sex and don't take it, then it has to be a different method. >> Yes. So, it might be a misconception. >> Yes. So, you can't take PrEP retroactively, everyone. >> And what does "retroactively" mean? Some people say, "But professor, it was just an hour ago." No, no. You need to take it at least 2 hours before having sex, and you need to take 2 pills. >> Uh, even if it just ended, just now. >> No. >> And if you don't take a condom. >> Alright, to be clear now. >> It might not help. >> So, the risk is normal. It's like not taking it, it might not help. >> Hey, it's not transmitted to everyone, professor. Meaning, even if it's HIV or undetectable, the chance of transmission is not 100%. >> Uh, I understand. >> But it depends on. >> There are many factors, many other factors. We think this is Part 1 of PrEP, which is very interesting. We'll move to the temple with the clear water. Let's follow. Yesterday, when we finished at Fushimi Inari, we planned to record more at the clear water temple. We went there, but it was 4 PM. And oh my, you tell me. There were about 3 million people. >> Oh my. And at 4 PM and 5 PM, it was still so hot that we couldn't record. >> Uh, so, it's okay, it's okay. I think we'll end today because if Fluke has to do another clip, he won't be able to. >> Let's keep it light. Because every day, until now, I've extracted all the knowledge from her brain. So, I think this will be the remaining part of clip 2. >> We'll continue to finish. And today, where are we now? >> We are in Nara, professor. >> Uh, so, again, I want to record this now. Maybe you can't see the atmosphere much yet, but I'll collect photos for you to see. >> Let's look at the deer. >> Let's look at the deer and then go to Todai-ji Temple. >> Which is the temple with the largest wooden Buddha statue in the world. >> Oh. >> And let's get back to our topic before we continue. Fluke, yesterday, I don't know what we talked about. I don't remember. But I have to claim this now. This is another disclaimer. Every time you have sex, you must protect yourself. Even if you take PrEP, you must. >> Use a condom. Uh, uh. Don't be careless. And I don't know what that means. >> Because there are other sexually transmitted diseases that we don't know about. >> PrEP doesn't cover them. >> Yes. But there's also new research that there's an antibiotic that can be taken. For example, after we have sex, and we're not sure if the person we had sex with has other sexually transmitted diseases, like gonorrhea, or chlamydia. And also syphilis. There's research, but taking this medication after sex to prevent infection, the result might not be 100%, but it helps. >> There are two questions. The first question is. >> Can you buy this? >> In Thailand, it's. >> Thailand. >> Thailand, you can buy everything, professor. Actually, maybe. >> But abroad, if it's in Canada, you need a doctor's prescription. So, the doctor will prescribe it along with PrEP. If you go to get PrEP, the doctor will ask, "Oh, you're taking this like a steamed bun, a dim sum. Take more." If you feel, "Oh, oh, there's a deer lying there, professor." >> Uh, let's see the fat one, look at the fat one, the fat one is sleeping, sleeping. >> There's a deer. >> Is it Children's Day today? >> Uh. >> I want to walk away from here. >> Okay, wait. Just now, just now, Fluke mentioned the medicine. Did you know the name of the medicine? >> Oh, the medicine is doxycycline. >> Okay. >> It's an antibiotic. But before taking it, you can't just go buy it and take it. You have to talk to the pharmacist, talk to the doctor to make sure you don't have any allergies or any previous side effects. Okay. >> Excuse me. Oh, the fat one. Sorry, the fat one. >> Uh, I had to stop just now because I was attacked by a herd of deer. But let me continue. There were two questions. The first question is, you can't buy it off the shelf. >> Maybe you can, but you have to talk to the pharmacist. Nowadays, pharmacists don't really keep up with drug classes anymore. Because I haven't been to Thailand for over 10 years. >> Ah, the next question is, how is the dosage? Meaning, do you take 200 mg? >> Normally, it comes in 100 mg pills. So, you take 2 pills, and you take it within 72 hours. >> After having sex. You take it once. >> You don't have to take it for a week, right? No, no, no. You take it for prevention, not for treatment. Treatment would be a different dosage, and you'd have to take it for a full week. But this is for prevention, so you take it within the risk period when the infection is not severe. >> Just once. But the sooner you take it, the better. >> I read somewhere that if you take it within 24 hours, it might be more effective than 72 hours. >> There's one more topic before we end this. >> Today, we read the news. >> Ah, we, we. >> Oh, it's news from Canada. In Thailand, you might not hear it often. When there are people who, oh, euthanasia. >> Euthanasia. >> Euthanasia. In Canada, there are times when we see that a famous person in society applies for this, and they get approved. >> So, applying for euthanasia, let's talk about it lightly first, professor. It's the ability to choose the day we leave this world. From another perspective, the patient has the right to choose the last day of their life. >> Yes. >> By themselves. Plan their own plan. >> Yes. But in Canada, it's not like anyone can just go and say, "Oh, I'm leaving." You have to submit an application. >> You have to talk to 2-3 doctors at least. Talk, talk freely. Talk to psychiatrists, etc., to get their signatures. Collectively, they sign and certify that, okay, if the disease is incurable and will progress, and there's no way to recover, and it will make your mind, if you live for another year or two, you won't be the same, you won't be able to make decisions. Then they will let you go. >> And after they let you go, they will set a date. You can choose the date. Professor, we're talking about the main points because many people are interested because it's becoming more news. For example, the other day, you read this. I read another one. A mother told her child to travel. >> And then? >> And then go. Uh. >> Yes, this is harsh. The mother said, "Mom wants to go to Switzerland." Switzerland is a country where it's possible. It's not possible in Canada. In Canada, you have to be Canadian, a resident of Canada, to be allowed. >> Uh, this is for foreigners. It's ours. We don't have this issue. Everyone should have the right to. >> Decide. >> At least everyone should have an option. >> An option of their own. >> But today, the conversation is because most people who decide are those with serious illnesses. >> Yes. >> Uh, a deer is coming. The person with a serious illness, like this one, has demi. >> What? Okay, the last one, you can't help yourself, can't do anything. >> This is how it is. There will be limitations. It's not like we are healthy. >> And we don't want to live in this world anymore. >> You probably can't. No. They will reject it and ask you to study other things. There are many factors involved. But we think, beyond the ethical issues, in the context of euthanasia, it's also a religious issue. Abortion. Abortion is not allowed. You know, it's a religious issue. We should, but let's not bring it up. >> Yes, yes, let's not. Let's not say anything about ending a life. Because abortion is also ending a life. So, it's beyond ethics. It's also a religious issue. >> It's something that needs to be discussed for a while longer. >> Which we won't talk about on this show. But I'm just saying that right now, it's something that's an option. Honestly, if I were in a critical condition, very sick, lying like a vegetable. >> Uh. >> I wouldn't want to live. >> Honestly, what we are facing now, professor, is somewhat similar. Sometimes we have the option to pull the plug or turn off the switch. >> It's similar. It's similar. >> Something like that. It's similar. But why don't we make this process systematic and standardized? And then the person can decide. >> Straightforward. And let it be known in advance. >> Because actually, this unplugging is also an interesting topic. So, who decides? The doctor alone? Or can the patient also decide? >> And why wait until that moment? >> Correct. I don't know. I think the cost in Switzerland might be expensive. >> Expensive. >> Yes. >> But in Canada, it's free. >> Dying for free. It's called medical care. You might have to pay a little. >> We think, we think in Thailand, it will be a long time. Because I think, even in developed countries, this issue is still heavily debated. >> Let's go back before we end the clip. Regarding Nara, I'll say this. My friends might hate me. I'm a bit annoyed with Nara, even though I like Nara. It's the chaos. The deer are a source of chaos. They are cute, yes, but they are chaotic. Secondly, there's a smell. >> It's still better than. >> Uh, but they are tame, and it's Nara's selling point. Cute. >> Yes, yes. And they are not aggressive. >> And we just walked out of the station, and we are in Nara Park. And as I said, we are going to Todai-ji Temple. >> Right? I'll tell Fluke that we have many opportunities to take photos with the deer because there are so many deer. The last time I came, I was with Krisda. >> Uh. >> Actually, personally, besides the deer, I've told many people that if I couldn't live in Kyoto, I'd want to live. >> In Nara. I wouldn't live here. I wouldn't live with the deer. I feel it's an old capital. >> Uh. >> And there's peace. There's tranquility. >> Uh, let's say if I lived in Nara, I could still go to work without difficulty. >> Because I can still work. How long did it take to leave the house today? >> 1 hour and a half. >> 1 hour and a half. And then the train, 2-3 transfers, but it's not that difficult. >> Yes, yes. >> This afternoon, after Nara, which is okay, we are in Kyoto. We took the train to Nara. We took the subway. >> Uh. >> And when we go back home, we can stop by Uji. Uji. >> Which is the green tea city. Of course, Fluke has never been there. And I went to Uji with Krisda as well. >> Oh. >> So, I think I'll collect some photos. Uji is definitely the green tea city. Personally, I like it very much. I like green tea. And Uji is a tourist destination. You have to prepare yourself. >> Today. >> Uh, but it's quite peaceful. There's a river, you can chill, drink green tea, drink matcha, and so on. And tomorrow will be Fluke's last day before going to Kansai. We plan to walk around Osaka a bit because he hasn't been to Osaka yet. >> Like, real Osaka. We might have more than half a day to spend in Osaka. So, okay, that's it. I hope, besides the beautiful scenery, you've also gained some knowledge. A little bit. Plus the last clip. So, there's nothing much more. >> Okay, then the two of us will say goodbye to our viewers. From Nara. And we'll bring back photos of the deer. Don't forget to like, share, and subscribe. >> If they have HIV but take medication every day until they are undetectable. >> Undetectable. Don't say that. >> Say it. The viewers want you to say it. >> I understand, I understand. But we're talking about the case of. >> Khun Maeow, P. Kijakobkijwattana, Khun Maeow, hello. How did you get into creativity? Actually, there are many creative jobs, 108,900. Why did you combine it with politics? Especially the recent important work, helping Khun Chatchart, reached a saturation point. And I felt that the advertising society of that era, as you know, professor, was a very slim society. >> One thing I want to ask about England. Actually, what were you doing in England for 2-3 years? >> I. >> Let's put it this way, Khun Maeow, were you shocked by the election results? >> Not shocked at all. I think the public feels the big structural changes. But I think right now, the economic situation of the grassroots is very bad. Professor. What do you think about the Pheu Thai Party and Khun Thaksin? Is it over? Is it at a dead end? Regarding the coalition, regarding performance, there are many questions. And the role of the "bag carrier." I'd like you to comment on the government that will be formed, led by the Bhumjaithai Party, for the next 4 years. >> Let's talk about the first thing. I, I'd like to say just a little bit about Khun Supachai. Actually, I think the election results.