From a public health perspective, harm reduction is not confined to lowering biological risk alone. It must also address the behaviours that generate that risk. While HIV pre-exposure prophylaxis, or PrEP, is effective in reducing the probability of HIV transmission, it does not modify sexual risk behaviour and cannot replace personal responsibility or behavioural change.
From the standpoint of the Health Belief Model, behaviour is strongly influenced by an individual’s perceived susceptibility and perceived severity of harm. When PrEP is introduced without structured behavioural intervention, it may substantially reduce the perceived risk of HIV transmission. This lowered perception of harm weakens the motivation to change behaviour, resulting in the continuation, or even escalation, of high-risk sexual practices. In this context, PrEP risks undermining the behavioural drivers essential for sustainable prevention.
When PrEP is promoted without mandatory and structured behavioural interventions, it ceases to function as genuine harm reduction and instead becomes a mechanism that enables the continuation of unhealthy and high-risk sexual behaviours under the false assurance of biomedical protection. This represents a shift from prevention to harm containment, which is inconsistent with established public health principles.
Beyond biomedical and behavioural considerations, public health interventions must also recognise the moral, ethical, and spiritual dimensions of human behaviour. For Muslim communities in particular, health promotion should not be detached from faith. Islam emphasises accountability before God, moral conduct, self-restraint, and the pursuit of what is good and beneficial for oneself and society. Prevention strategies should therefore encourage individuals not only to avoid harm, but also to return to values grounded in belief in God and commitment to doing good.
Crucially, HIV prevention and control cannot be addressed by the Ministry of Health alone. It requires a deliberate, coordinated, and sustained multi-agency approach. Ministries responsible for education, youth and sports, higher education, religious affairs, social welfare, women and family development, as well as law enforcement, community leaders, religious institutions, non-governmental organisations, and families must all share responsibility. Behaviour, values, and social norms are shaped far beyond the healthcare system, and ignoring this reality weakens any national response.
The provision of PrEP must therefore be embedded within a comprehensive and structured prevention framework that is multi-sectoral by design. This includes rigorous behavioural risk assessment prior to initiation, continuous sexual health counselling, reinforcement of safer practices, adherence monitoring, and periodic reassessment of ongoing need, supported by education, moral guidance, and community engagement across multiple agencies. Without these elements, the use of PrEP risks normalising sustained high-risk behaviour and may contribute to rising rates of other sexually transmitted infections.
A relevant comparison is nicotine replacement therapy. Nicotine patches are never offered in isolation. They are part of structured cessation programmes with counselling, monitoring, and a clear objective of stopping smoking. PrEP, in contrast, is too often framed as a long-term biomedical solution without a defined behavioural trajectory or exit strategy. This difference is significant and must be addressed in policy and implementation.
If the Ministry of Health advocates PrEP as part of the national HIV prevention strategy, it carries a responsibility to ensure that its delivery is ethically sound, behaviourally anchored, and evidence informed. Biomedical tools must support behavioural change, moral responsibility, and ethical reflection, not substitute for them, and this must be reinforced through coordinated action across agencies.
PrEP can play a role in HIV prevention, but only as an adjunct within a structured, monitored, behaviour-focused, values-conscious, and genuinely multi-agency strategy. Sustainable HIV control will not be achieved through medication alone. Behavioural modification, ethical responsibility, moral guidance, and shared societal accountability remain central and must be treated as non-negotiable components of any effective national HIV prevention programme.