In Summary
  • So has PrEP taken over abstinence, faithfulness and condoms? Does this new method encourage reckless sexual behaviour – or is it finally an admission that human beings are incapable of sufficiently controlling their urges?
  • Dr. Vernon Mochache of the National Aids Control Council (NACC), which was one of the partners in the May rollout, says that this concept of someone who has been exposed to the HIV virus taking medication to prevent infection is not new.

Pre-exposure prophylactics, also known as PrEP, are drugs that can prevent one from being infected with HIV.

With their rollout to the general public in May this year, Joan Thatiah asks if PrEP will take the place of the other three pillars of anti-HIV infection measures.

“Suzie is a beautiful woman with many lovers: Edwin sets the rhythm of the week. When broke, old Micky chases away her blues. And David the ex is on speed dial for personal emergencies. Suzie doesn’t know that Edwin parties recklessly, David is HIV positive and she is not the only fly in old Micky’s web. Suzie doesn’t always use condoms. She is not safe, she also needs PrEp.”

This is part of the script of an advert that has been running on YouTube, promoting the May 2017 Kenya rollout of the pre-exposure prophylactic drug (PrEP) as a new way to prevent HIV infections. The drug is called Truvada, and Kenya is the second African country after South Africa to embrace it.

So has PrEP taken over abstinence, faithfulness and condoms? Does this new method encourage reckless sexual behaviour – or is it finally an admission that human beings are incapable of sufficiently controlling their urges?

Dr. Vernon Mochache of the National Aids Control Council (NACC), which was one of the partners in the May rollout, says that this concept of someone who has been exposed to the HIV virus taking medication to prevent infection is not new.

“It has been used for years, especially with mothers during the antenatal clinics. It been known to work. This rollout is just making the same available to the general population.”

Who is the target? “Anyone who considers themselves at risk. If you are in a discordant relationship and are HIV negative, you will want to protect yourself. Then there are the Key Population Members, like people who inject drugs, men who have sex with other men and sex workers,” explains Dr. Mochache.

According to statistics from the Joint United Nations Programme on HIV/AIDS (UNAIDS), HIV prevalence is estimated to be up to 28 times higher in people who inject drugs, 12 times higher amongst sex workers, and 19 per cent higher amongst homosexual men.

Is it a replacement for condoms? “No. PrEP is not a substitute for safe sex and regular scheduled HIV testing. It is an additional method of preventing HIV infection. Other methods like condoms offer dual protection as they also prevent pregnancies and other STI’s.

PrEp should be used as part of a package,” explains Dr. Mochache.

Even though Kenya has one of the world’s highest HIV testing rates (72 per cent of the population has been tested at least once in their lifetime), the AIDS epidemic is far from over.

According to data from the National Aids and STI Control Programme (NASCOP) 71,034 people aged above 15 years were infected with HIV in 2015.

Young people significantly contribute to the HIV burden in the country. People aged between 15 and 24 contributed to 51 per cent of adult new infections in 2015.

When you look at the numbers, you notice that women are at a much higher risk than men: A 2014 report from the National Aids Control Council showed that women in Kenya are more vulnerable to HIV infection, with the numbers at 7.6 per cent prevalence compared to 5.6 per cent in men. In Sub-Saharan Africa, women and girls account for one in every four infections.

Perhaps this indicates the inability or fear of women to speak up for themselves when it comes using prevention measures like condoms, as happens with birth control.

How effective is it? Statistics from NASCOP show that if taken every day, the PrEP pill has a between 84 and 96 per cent success rate in the prevention of HIV infections. If not taken every day, its effectiveness is lowered significantly.

Joyce Ng’ang’a, a policy advisor at World Aids Campaign International (WACI) – Health reckons that PrEP is a good answer for discordant couples especially those seeking to have children or those where one partner has a detectable viral load.

“It works well for people in relationships. There is however a select group of people who we can’t ignore – people, especially the younger generation, who are not in a relationship and who can’t predict when they are going to have sex. PrEP needs to have been in your system for seven days prior to exposure for it to give protection. This means that it is not an effective solution for people who do not necessarily plan to have sex,” she explains.

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