The use of antiretroviral – specifically, the oral use of Truvada – for the prevention of HIV infection among those at high risk for contracting infection, is considered a game changer. There are substantive evidence to show that PrEP is effective in reducing the risk of HIV acquisition across types of sexual exposure and sexes – male, female, transgenders, cisgenders. PrEP is already contributing to the reduction in HIV incidence among gay men and other MSM in parts of the US and the UK.
For Africa, those at high risk for HIV infection - those in communities and sexual networks with around 3% HIV incidence or higher – are not only MSM but also women: female sex workers, women in heterosexual relationships, adolescent girls, women who inject drugs. Consistently, the data shows that HIV infection in these populations are higher than that of the general population. Changing the face and dynamics of HIV infection in Africa implies addressing issues related to women.
Those same dynamics that increases the risk of women to HIV in Africa are also the same factors that affect her ability to adhere consistently to PrEP: the increase risk for gender based violence and community tolerance (even by women) of domestic violence; low risk perception often resulting from low level education about self, health and HIV; and poorer access to health commodities.
Recently, experts attending the 2017 IAS conference in France concurred that intermittent use of oral PrEP probably would not work for women to prevent HIV via vagina sex: six to seven doses a week may be needed for full protection. Daily PrEP and good adherence would be needed to fully protect women who practice vagina sex from acquiring HIV infection. Women may also need to start taking PrEP several days – as much as 7-8 days - in advance of possible HIV exposure to have good protection. While four to five doses of PrEP a week almost complete protection in men who have sex with men (MSM), seroconversions have been reported in women who use these doses. No infection has however been seen in women who take six or seven doses of PrEP week. The implication is that women may want to combine oral PrEP with other old and new HIV prevention methods – condoms, vagina rings.
For girls and women in Africa where consistent clinical trial data shows that adherence to study products is a challenge; where condom use is low especially for those in relationships; where the health system is weak and overburdened and may not be able to provide the needed support for girls and women who choose to use PrEP; where hither do we go from here - what do we do to help ourselves?
No comments