The new face of HIV prevention

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.

She thinks of it as a combination prevention, meaning that it is a collection of solutions. This is why she insists that even if one is takin PrEP, other methods like condoms and reduction of the number of sexual partners should not be ignored.

This is also why she is running Africa Free of New Infections (AfNHi) a group of advocates pushing for governments to invest more in research to give forth new tools that will work for everyone.

Peninah Mwangi who is the executive director of the Bar Hostesses Empowerment and Support Programme (BHESP), reckons that there is not a single solution when it comes to HIV.

“Condoms are the most used method of preventing HIV infection because they are accessible, cheap and readily available. But they haven’t been 100 per cent effective. Most of the times, the woman is not in control,” she says.

In the event of discordant couples, she observes, it may not be possible to use condoms all the time in a family setting. PrEP on the other hand, offers confidence to women with regard to their sexual health. So far, 2,700 women under her organisation all over Kenya are taking PrEP.

“It is working and donors have made it so that those who need it can access it for free at government health facilities,” she says.

PRESSING CONCERNS

The most pressing concern when you mention PrEP to anyone is that people taking it will become more sexually reckless.

A 2012 survey conducted by the Ministry of Health through Kenyatta National Hospital amongst discordant couples shows that PrEP use does not result in behavioural inhibition or sexual recklessness.

In fact, because of the counselling that comes with its administration, PrEP use has been seen to come with improved sexual behavior, like more condom use.

Once you begin taking it, does it mean that you need to take it for the rest of your life?

“No. You take it for as long as you feel you are at risk. If you feel you are no longer at risk of infection and you need to stop, see a health care provider. They may advise you to continue taking it for up to four weeks after your last exposure,” explains Joyce Ng’ang’a.

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Do you think PrEP is the answer to the HIV pandemic?

Margaret Wambui, 29
Yes and no...The government and society should focus on re-instilling values in the youth and young adults. It is also evident that the young adults have lives of their own. We can’t deny the fact that they are having sex. So yes, if they if someone feels they are at risk, they should take PrEP. I would.
Faith Daudi, 27
I think PrEP could be answer. It is both good and bad. People are already recklessly having sex so this could get worse. But this is also our reality. We can’t run from it. PrEP will help especially with the new infections. People should take it.
Damaris Wangari, 30
 PrEP would only be an answer if other protection methods like condoms were used together with it. I’m afraid that the rollout may encourage reckless sex leading to the rise in other sexually transmitted infections which PrEP can’t prevent. I think people should also think about the side effects.
Cecilia Njeri, 30
As a young Kenyan woman, I think PrEP is a way of protecting people from getting the virus. A lot of people do not use condoms correctly or consistently. Others do not use them at all. There are people putting themselves at risk every day, knowingly and unknowingly. PrEP could be the answer.

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ABC’s of PrEP

 It is not an emergency pill that you can pop once after a sexual encounter. You need to be taking it for about seven days before you are effectively protected.

 You must take a pill every day. It’s not to be taken only on days that you think you will have sex.

 PrEP only prevents HIV infections. It will not prevent pregnancies or other sexually transmitted infections.

 You can’t get HIV from taking PrEP. If you take it regularly as you should, it will give you protection from HIV.

 PrEP does not give you permission to be sexually reckless and promiscuous. It is