South Africa has announced that thousands of HIV-negative sex workers will be eligible to receive antiretrovirals (ARV) to help prevention of HIV infection.
An inability to negotiate condom use, stigma as well as sexual and gender-based violence are just some of the reasons why sex workers are at a high risk for HIV.
Read: When condoms aren't enough: To PrEP or not to PrEP?
A study conducted among about 2 200 sex workers in Johannesburg, Durban and Cape Town found that about 72 percent of sex workers surveyed were living with HIV. While more than 90 percent of sex workers said they had recently tested for HIV and the majority of those living with the virus knew their status, less than one-third of HIV-positive sex workers were on treatment.
As part of the newly unveiled South African National Sex Worker HIV Plan, all sex workers will be started on HIV treatment as soon as they are diagnosed. Currently, most people living with HIV must wait until their CD4 counts – a measure of the immune system’s strength – fall to 500 before they can start treatment.
At least 3 000 HIV-negative sex workers will be given the ARV Truvada, which combines the ARVs emtricitabine and tenofovir, as pre-exposure prophylaxis (PrEP) to help prevent them from contracting HIV.
Confused? Here are the five things you should know about PrEP.
1. What is PrEP?
“PrEP provides an additional prevention option for those who are at high risk for HIV,” explains Dr Saiqa Mullick, director of implementation science at the Wits Reproductive Health and HIV Institute.
“It’s an ARV drug in the form of a tablet and it’s for HIV-negative people. It needs to be taken daily to significantly reduce the chances of getting people,” she adds. “It works if people are taking it everyday but they don’t need to take PrEP for the rest of their lives – only during the period of their life when they are at a significant risk for HIV”.
It’s important to remember that the ARVs used in Truvada also form part of standard HIV treatment when combined with a third ARV. People who use PrEP will have to regularly test for HIV to ensure that they are switched onto a three-drug regimen should they contract HIV to avoid developing drug resistance.
2. What’s the evidence that PrEP works?
According to the South African National AIDS Council, 12 clinical trials have tested the effectiveness of oral tablets for PrEP in Africa, Asia, Europe, South America and the United States. Daily PrEP has been shown to lower a person’s risk of sexually contracting HIV by more than 90 percent.
3. Is it safe?
The efficacy and safety of Truvada as PrEP has been tested in 10 randomised clinical trials, according to the Southern African HIV Clinicians Society.
PrEP can cause initial side effects like nausea in some people, according to the US Centres for Disease Control but side effects are rare.
“There’s a lot of myths that the drug is toxic and that there are side effects,” said Dr Kevin Rebe, specialist medical consultant for the Anova Health Institute. Rebe runs a small programme offering PrEP to men who have sex with men in Cape Town. “Side effects are only present in one in 10 patients."
Some patients have experienced moderate declines in kidney function associated with higher doses and older age, according to two major studies presented at the recent Conference on Retroviruses and Opportunistic Infections.
According to researchers, the findings indicate that while PrEP is generally safe, clinicians may ask to monitor a patient’s kidney function to catch any problems early. The Southern African HIV Clinicians Society currently recommends that PrEP only be given to people with normal kidney function.
“PrEP isn’t for everyone but it might be for quite a lot of us,” Rebe said.
4. Is it only available for sex workers?
South African drug regulatory body the Medicines Control Council (MCC) approved Truvada for use as PrEP in December. According to Rebe, the MCC’s approval means that anyone is free to ask their doctor if PrEP is right for them.
“In reality, PrEP has been available for years,” said Rebe, stressing that HIV-negative people at high risk of contracting HIV who are interested in PrEP must be tested for HIV and kidney function first. “Any general practioner (GP) who is savvy really could just write a script for this."
Medical aid Fedhealth has said it will cover at least six months of PrEP for medical scheme members who are at a high risk of HIV as well those who are in relationships with HIV-positive partners.
To qualify for this benefit, doctors must register members on Fedhealth’s Aid for Aids PrEP Programme, according to a statement issued by the company.
5. How much does it cost?
A monthly course of PrEP ranges from about R200 to R550, according to Rebe. – Health-e News.
Sex workers to get HIV treatment, ARVs (Health24) http://www.health24.com/Medical/HIV-AIDS/News/sa-rolls-out-hiv-treatment-arvs-to-sex-workers-20160314
Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection (Southern African Journal of HIV Medicine) http://www.sahivsoc.org/upload/documents/March%202016%20PrEP%20Guidelines.pdf
Modest kidney function decline in people taking Truvada for PrEP supports need for monitoring (Aidsmap) http://www.aidsmap.com/Modest-kidney-function-decline-in-people-taking-iTruvadai-for-PrEP-supports-need-for-monitoring/page/3040983/
South Africa licenses anti-retrovirals to prevent HIV
HIV: What is pre-exposure prophylaxis?
Sex workers to get HIV treatment, ARVs