January 18, 2017

Pre Exposure Prophylaxis: Where Does it Stand for Young Women?

UNAIDS reports that an estimated 2.1 million people become newly infected with AIDS each year, 60 percent are young women between the ages of 18 and 24. This means that every single day two thousand adolescent girls and young women become newly infected with HIV, almost two every minute. In response to these statistics, global leaders pledged to work towards ending the AIDS epidemic by the year 2030. This will include implementing the 90-90-90 treatment target: ensuring that 90% of people living with HIV know their status, that 90% of people who are aware they have HIV are receiving treatment and 90% of people on treatment have suppressed viral loads.

During the ‘International Conference on AIDS and STIs in Africa’ (ICASA) held in Zimbabwe in 2015 I met Rudo (a pseudonym to protect her identity),a 24 year old sex worker in Zimbabwe. When her parents succumbed to AIDS, she was sent to live with relatives, where she had to deal with the shock of intra-familial sexual abuse. At the age of 14 she found herself pregnant and living on the streets after running away from this abuse. Without any skills and lacking a formal education Rudo turned to sex work to financially provide for herself and her daughter. The decision to enter the sex industry was out of desperation and she soon found it very difficult. There are several contexts, dynamics and factors that put Rudo at a higher risk of HIV/AIDS transmission, including, but not limited to, a lack of access to condoms and a risk of violence. In addition, Rudo says she has been beaten and subjected to humiliating and painful sexual acts from her clients, who are sometimes violent towards her. Although Rudo is conscious of the need to use protection or engage in safe sex, the decision is often beyond her control. Her clients sometimes refuse to use condoms, and use intimidation or violence to force unprotected sex.

Violence is very much a part of Rudo`s life, as it is for a significant number of women in Zimbabwe. A survey conducted in 2015 found that 1 out of 3 women in Zimbabwe reported physical abuse from an intimate partner. Because HIV enters the body more easily where there is broken skin on the vaginal wall, sexual and physical violence makes it even easier for young women to get infected with HIV. Subsequently , it seems like an impossible task to reduce new HIV infections without addressing the issue of gender based violence.

Is there a tangible solution to help young women, such as Rudo, to cope with these challenges? The answer might be simple: Pre Exposure Prophylaxis (PrEP). PrEP is a powerful HIV prevention tool, involving two medications called Tenofovir and Emtricitabine, and by taking a pill every day people who are at very high risk of getting HIV can prevent infection. In four randomized control trials, PrEP reduced the chance of contracting HIV by up to 96%.

Although PrEP is not the magic bullet, its potential to change the HIV trajectory is huge. PrEP can be taken and kept discreetly, bypassing the need for consent from an abusive or controlling partner who does not wish to use protection. In addition PrEP can also be taken during high risk times, for example, as a stop gap measure for someone working towards getting out of an abusive relationship or sex work. The pill can be taken and stopped with very minimal risk of resistance in the rare chance that someone on PrEP gets infected. Although PrEP only provides protection against HIV, other STDS are generally easily treatable and contraceptives are widely available if one wants to prevent pregnancy.

Rudo is a participant in a demonstration project for PrEP, targeted at sex workers in Zimbabwe, and has been taking it for over a year. In spite of the harrowing tales she narrated to me, she, like many of her colleagues in the study, remains HIV-negative. The study consists of over 2000 participants.

Opponents of PrEP usually cite, as a concern, the high cost of Truvada, which is a component of the drug. I, however, believe that the reduction in the number of new HIV infections, rather than an increase in the number of people who will need to be put on lifelong Anti Retroviral Therapy, will mean the use of PrEP will actually turn out to be cost-effective in the long run.

It is impossible to examine all the issues surrounding PrEP in one article, but PrEP can potentially prevent a high percentage of new HIV infections for those who take it religiously. This potential certainly needs to be explored, for the sake of the future of young African women. The point I am making here is that we need to think of HIV prevention tools as being in one huge basket from which those at risk can choose. In which case, we can add PrEP as an additional tool which can go a long way to help the world achieve its goal of ending AIDS by 2030. I am convinced that in the absence of a female controlled HIV prevention method, which does not depend on the cooperation of the male partner, PrEP gives young women the best possible choice.

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About Anna Miti

Anna Miti

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