Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Erica Herzog


Pre-exposure prophylaxis (PrEP) is highly effective in human immunodeficiency virus (HIV) prevention for key populations, including men who have sex with men (MSM). In Malaysia, human immunodeficiency virus (HIV) prevalence among MSM is 22%, and is even higher in key urban areas, including Kuala Lumpur. Despite nationwide campaigns committed to address HIV, scale-up of PrEP for MSM in Malaysia has been suboptimal. This limitation can be attributed partially to concerns that PrEP will lead to increased sexual risk behaviors, based on the controversial theory of risk compensation.

A 2018 PrEP demonstration study of MSM in Malaysia (n=150) was used to assess changes in sexual risk behaviors after PrEP initiation, exploring risk compensation. Changes in sexual risk behaviors between baseline and follow-up (months 3, 6, 9, and 12) were tested using Wilcoxon signed-rank and McNemer’s tests for non-parametric continuous and paired binary variables, respectively. Generalized estimating equations were used to model risk outcome behaviors. Significance was set at p

Participants were mostly single (62.0%), gay (92.0%), young (mean age: 31.33 + 7.36), and employed full-time (81.3%). Participants reported a small but statistically significant increase in sexual partners compared to baseline at all timepoints (all p

Lack of associations between baseline HIV risk perception and changes in any sexual risk behavior, as well as lack of changes in CAS and CAS with an HIV+ partner, undermines the notion of risk compensation in MSM while using PrEP. We advocate for the Malaysian government’s endorsement, subsidization, and increased utilization of PrEP in the MSM community.


This is an Open Access Thesis.

Open Access

This Article is Open Access