Kenya’s health authorities launched a new way to reduce the spread of HIV among its people.
This pre-exposure prophylaxis (PrEP) joins other prevention and treatment methods already in use in Kenya. It involves giving antiretroviral (ARV) drugs to people who are not infected with HIV but are at high risk of infection. Taking the drug reduces the chances of HIV infection.
Over the last thirty years, 77 million people worldwide have been infected with HIV and 39 million (51%) of them have died from AIDS related illnesses.
During the first 20 years of the epidemic, up to the mid 2000s, antiretroviral treatment was not widely available. In 2006, for example, less than 10% of HIV positive people globally were on ARV therapy.
In the 1990s, the ARV drugs were largely experimental and extremely expensive. In addition, patients had to take several different drugs at least twice a day. Because it was complicated, some patients either took the drugs inconsistently or stopped altogether.
Most of the world’s HIV infected people were in low-income countries. The question was how to finance such a potentially expensive programme of treatment.
Test and treat campaign
In the past, treatment was delayed until a person became very sick. Today, HIV positive people begin antiretroviral treatment as soon as they are diagnosed. This not only prolongs life but reduces the risk of new infections.
When a patient takes the medication properly, ARVs prevent the virus from multiplying. HIV positive people then become almost non-infectious and could, in theory, have unprotected sex with HIV negative people with little risk of infecting them with the virus.
Now, by making ARVs available to HIV negative people in the high risk group, Kenya is expected to significantly reduce their chances of getting HIV.
If the preventive treatment is taken as per instructions, it could reduce the risk of HIV by almost 90%. This means that if one hundred people who would otherwise get infected take the medication every day as recommended, 90 of them will likely not get infected. In reality, however, most people do not take medication as required all the time and most studies have shown an overall reduction risk by about 75%.
Patterns of HIV infection in Kenya
Progress in the fight against HIV has been accompanied by a major shift in the patterns of infection in Kenya.
Female sex workers, men who have sex with men, people who inject drugs and adolescent girls continue to be disproportionately affected by HIV. They account for almost 90% of new infections in Kenya. This is because unlike in the rest of the population where new HIV infections have gone down to a large extent, new infections have remained fairly constant among these groups.
In 2015, almost half of the new HIV infections in Kenya were among girls and young women aged 15 to 24 years. Their vulnerability to HIV infection is due to limited knowledge on HIV/AIDS. Young girls are also unable to negotiate for safe sex due to poverty and peer pressure. Female sex workers and men who have sex with men account for about a third of new HIV infections.
New prevention tool
In Kenya, the focus of PrEP is on female sex workers, men who have sex with men, HIV negative people in relationships with HIV positive people, and adolescent girls and young women in areas with high numbers of new infections.
The treatment is given as a daily tablet containing either one drug (tenofovir) or a combination of two drugs (tenofovir and emticitrabine).
Both are common ARV drugs often used as part of the treatment for HIV positive patients. In addition to oral PrEP, there are other forms of HIV prevention such as vaginal rings and gels, but they are not as widely available as the tablets, anywhere in the world.
Research is continuing into other forms of PrEP such as a monthly injection to make it easier for people to follow the treatment.
Efficacy and safety profile
This medicine does not work well if the person doesn’t closely follow the instructions for its use.
It is useful for HIV prevention, but does not protect against other sexually transmitted infections or unintended pregnancies.
It is very safe to use, though. It can have side effects like mild abdominal discomfort, nausea and vomiting, but they clear up within two weeks of starting the treatment.
There is only a small risk of kidney and liver damage for people who already have kidney disease due to high blood pressure, infections or diabetes. PrEP is also safe in pregnancy and does not interfere with most family planning methods.
Governments need to start and continue public health campaigns to increase awareness of this HIV prevention method. This will help high risk groups to protect themselves from infection.
Campaigns should make sure that women know about PrEP, because it may be easier for them to take tablets than to get a man to use a condom.
Until there is a vaccine or a cure for HIV, success depends on using all the available ways of preventing infection.