Public Health First: Reaffirming the Role of Pharmacists in Equitable PrEP Service Delivery

We read with interest the article titled “Pharmacist Advocacy in Pre-Exposure Prophylaxis (PrEP) Implementation Amidst Religious Debate in Malaysia” (Malaysian Journal of Pharmacy, June 2025). The authors have highlighted a timely and important issue at the intersection of religion, public health, and HIV prevention.

While acknowledging religious and cultural sensitivities in healthcare is important, it is equally vital to recognise Malaysia’s diverse, multiethnic, and multireligious society. Populations affected by HIV include substantial proportions of non-Muslims (estimated between 3% and 25%) [1]. Any national PrEP implementation strategy must therefore be inclusive and responsive to this diversity. The Ministry of Health Malaysia has reaffirmed that PrEP implementation is grounded in public health principles and aligned with the “Health for All” agenda, ensuring equitable access to HIV prevention, treatment, and care regardless of social status, race, or religion [2].

We acknowledge the authors’ efforts to highlight Islamic ethical principles such as darar (prevention of harm) and hifz al-nafs (preservation of life), which support the use of evidence-based HIV prevention tools, including condoms, opioid substitution therapy, and PrEP. These principles have guided past harm reduction efforts and are valuable in shaping public messaging and community engagement, reinforcing that PrEP is a permissible and necessary public health initiative aligned with the goal of preventing harm and preserving life.

However, we respectfully differ on the suggestion to embed religious content within the PrEP training module for pharmacists, as such integration may blur professional boundaries, reinforce stigma, or alienate clients and healthcare providers who do not share the same beliefs. Pharmacists should be equipped with core competencies such as PrEP eligibility screening, counselling, adherence support, drug-drug interaction awareness, safe dispensing, and person-centred, stigma-reducing communication, while upholding confidentiality [3][4]. While awareness of cultural and religious perspectives is valuable, religious content may complement training through optional modules or partnerships with religious leaders but must remain supplementary. In a multicultural society, healthcare training, including HIV prevention, should remain grounded in scientific evidence, public health principles, ethics, and human rights.

In reaffirming the role of pharmacists as public health advocates, we believe their primary responsibility is to support equitable access to HIV prevention by upholding an inclusive, rights-based approach that ensures all clients, Muslim and non-Muslim alike, can access care with dignity and without discrimination [5]. Balancing cultural sensitivity with public health integrity is key to advancing inclusive, effective, and respectful PrEP implementation in Malaysia.

CONFLICT OF INTEREST

The authors declare no conflict of interests.

REFERENCE

1. Ministry of Health Malaysia. Integrated Biological and Behavioural Surveillance (IBBS) Survey 2022. Putrajaya: Ministry of Health Malaysia; 2024. https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Final_IBBS_Report_2022.pdf  [Accessed 1 July 2025].
2. Ministry of Health Malaysia. 2024 Global AIDS Monitoring: Country Progress Report – Malaysia. Putrajaya: Ministry of Health Malaysia; 2024. https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/GAM_REPORT_2024-updated_22102024.pdf [Accessed 1 July 2025].
3. Viegas R, Ahmed A, Callier J, Ngaruiya L. HIV prevention, screening and management: A handbook for pharmacists. The Hague: International Pharmaceutical Federation (FIP); 2022. https://www.fip.org/file/5342  [Accessed 1 July 2025].
4. World Health Organisation (WHO). WHO Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection: Module 6 Pharmacists. Geneva: World Health Organisation (WHO); 2017. https://www.who.int/publications/i/item/9789240097230  [Accessed 1 July 2025].
5. Joint United Nations Programme on HIV/AIDS (UNAIDS). HIV PREVENTION 2025 – ROAD MAP: Getting on track to end AIDS as a public health threat by 2030. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2022. https://www.aidsdatahub.org/sites/default/files/resource/prevention-2025-roadmap-en.pdf  [Accessed 1 July 2025].