Image credit: STEPHANE DE SAKUTIN/AFP/Getty Images. From https://www.csis.org/analysis/worlds-largest-hiv-epidemic-crisis-hiv-south-africa
What is PrEP?
Pre-exposure prophylaxis, or PrEP, is medication taken by HIV-negative individuals in order to prevent possible HIV infection. It’s a pill that can be taken every day, or before and after sex, and is shown to be up to 99% effective in preventing HIV.
PrEP is still a relatively new method of HIV prevention, being first approved for use in 2012. Since then, however, its global use has grown rapidly, with almost one million people worldwide regularly using PrEP in 2021. Initial use of the drug was largely restricted to Western nations, however a new study shows that recent use in Africa has increased dramatically. Now, half the people using PrEP worldwide live in African nations.
PrEP works by ensuring there is a low concentration of HIV-fighting antiretroviral drugs in the bloodstream at all times, that can immediately destroy the virus if it enters the body. Currently, there are two different drugs with FDA-approval for usage as PrEP, known under the brand names of Truvada and Descovy. These both take the form of a single pill containing similar antiretroviral drugs.
PrEP can also be used in treatment of HIV-positive pregnant women, in order to decrease the likelihood of transmitting HIV to their child.
Why is PrEP so important for African countries?
Of the 38 million people living with HIV worldwide, over 2/3 are in Africa. This makes the recent growth in the popularity of PrEP in the continent a crucial and welcome advancement.
Seven of the top ten countries with highest PrEP usage are located in sub-Saharan Africa, with South Africa and Kenya taking the lead. In 2016, the number of people using PrEP in sub-Saharan Africa was just over 4,000; this number has sky-rocketed to over half a million in just four years.
Kate Segal, a manager of the HIV prevention non-profit Avac, stated that “South Africa recently achieved a huge milestone surpassing 100,000 initiations, Kenya is closely behind at 83,000 as of December 2020 followed closely by Zambia and Uganda.” This data was presented at a HIV Research for Prevention Conference in January, which highlighted how sub-Saharan African nations have succeeded greatly in ensuring the drugs are available to general populations. This contrasts the approach taken in many Western countries, who have largely focused on only providing PrEP to those who are most vulnerable to HIV, namely sex workers and men who have sex with men. For example, it only became available to everyone in the UK in March of 2020.
Eswatini, a country in southern Africa, has the world’s highest prevalence of HIV, with over 27% of adults living with the disease. This country of just over a million inhabitants now has more PrEP users than Germany, Canada or China.
Young African women are particularly susceptible to infection with the virus, as they commonly have limited access to reproductive and sexual health services. PrEP enables women to protect themselves in an environment where condom usage remains a mainly male-controlled method of protection. As well as oral medication, PrEP can be taken in the form of a Dapivirine vaginal ring, which protects against HIV infection for up to 28 days. This gives women who are vulnerable to infection a discreet and long-lasting method of control that doesn’t require daily medication.
“The ring is unique in a way that I do not have to get agreement from or disclose to anyone because it is discreet. It gives me power that I can protect myself without seeking consent from anyone” said Cleopatra Makura, Zimbabwean HIV and AIDS advocate. The Dapivirine ring was approved for use in Europe last year, and it is hoped that it will be provide a popular method of HIV defence amongst young African women in the near future.
Currently, lack of knowledge surrounding PrEP, stigma of its use and its cost are all limiting factors to its use. It is hoped that increasing awareness and uptake of PrEP will help to eradicate HIV across the world, with African countries leading the way. Considerable progress has been made towards the UN health agency’s goal of ending the AIDS epidemic in all nations by 2030; the role of PrEP in achieving this target is clear.