A Pill a Day to Prevent HIV

“PrEP is Bonga point for HIV protection,” says Pendo, a sex worker, after I asked her understanding about Pre-Exposure Prophylaxis {PrEP}.

Pendo, who started sex work in 2000, is among dozens of Nairobi female sex workers who have enrolled for PrEP.

PrEP is a way for people who don’t have HIV but are at very high risk for HIV infection take HIV medicines daily to lower their chances of getting infected.

National AIDS Control Council {NACC} 2014 report titled “Kenya HIV County Profiles” reports Kenya has an average HIV prevalence rate of 6% and with about 1.6 million people living with HIV infection.

While according to 2014 UNAID’s Gap Report, HIV prevalence is estimated to be 12 times higher among female sex workers than among the general population.

“The lady who introduced me to sex work told me self-protection is the best. Over the years, I have been on condoms and lubricants. So when I heard about PrEP I immediately enrolled,” she says.

Pendo, who has been on PrEP for the last 3 months, says despite experiencing slight side effects during few weeks after starting PrEP, she has come to like the HIV intervention as she now has greater protection than before.

“I always tell my colleagues to be protected with 3 tools- Condoms, lubricants, and prep. The girls ask me if they should stop using condoms because they are taking PrEP but I tell them PrEP doesn’t give you any protection against other STDs.”

“I tell them while PrEP can significantly reduce their risk of HIV infection, they can combine additional strategies like condom use with PrEP to reduce their risk even further,” says Pendo, who is Bar Hostess Empowerment and Support Programme (BHESP) PrEP ambassador.

BHESP Oral PrEP Project Officer Mercy Wafula says the pilot one-year PrEP project targets 600 female sex workers in Nairobi and currently 200 are using prep while 378 have been screened for eligibility and are awaiting results.

She attributes the slow uptake to lack of willingness on the side of the sex workers to take the pill and distress if PrEP will be easily available and accessible in future.

“We are using the 9 PrEP ambassadors who have been trained on PrEP to create demand for the pill among sex workers. They do it through one on one communication, outreaches, and hotspots,” Wafula explains.

Adherence makes all the difference to the efficacy of PrEP and according to Wafula 80% of sex workers on PrEP have adhered to their medications while 20% have not.

“People are adhering, they are taking it as per the prescription but the only challenge is timing due to the nature of their work. Others have relocated to different towns,” she says.

As a PrEP Ambassador Pendo says she advises her colleagues who have enrolled for oral prep to take their pills daily and to correctly and consistently use condoms.

“Some of them tell me they don’t want to take PrEP because when they take it they will have unprotected sex. Others say they will not get pregnant if they use PrEP. While others say after the pilot project they will be paying ksh.100, 000 to get the pills. I tell them those are pure lies,” Pendo adds.

Among the 200 female sex workers who have enrolled for PrEP is 25 years old Justina who has been on the medication for the last four months.

“I use the pill to protect myself because I am still very young and in the near future I want to get married and have a family,” says Justina who has been a sex worker for the last six years.

Despite the daily pill playing a pivotal part as an HIV prevention strategy in the life of Justina, her colleagues have branded her saying she is HIV positive.

“I went with a client to his place and I decided to take the pill as per my timing. Immediately I opened the tin, the client chased me out accusing me of knowingly infecting him with HIV. He threw me out without paying me. Nowadays I fear to take my pills while people are around,” reveals Justina.

Centre for Disease Control {CDC} reports that in people who are HIV-negative and have taken PrEP for up to 5 years, no significant health effects have been seen.

However Lilian, a sex worker who hails from Nairobi Eastland’s area, says she hasn’t enrolled for oral PrEP because she believes the pills are Antiretroviral {ARVs} drugs and will have an adverse effect on her kidney.

“Others tell me that if you use PrEP you will feel dizziness the whole day. So I just stick to condom and lubricant as part of my prevention. I also consume a lot of alcohol and I am sure that will have an effect on my adherence,” she explains.

For Milka, who has been in the oldest profession for the last ten years, says PrEP is the best thing that has ever happened to her life as she is not afraid of contracting HIV.

“Before I enrolled for PrEP, I encountered 3 condom burst and I took Post Exposure Prophylaxis {PEP} 3 times. But immediately I heard about PrEP, I was among the first to join,” she explains.

While responding to the issue of sustainability of the PrEP project, BHESP’s Executive Director Peninah Mwangi says they have partnered with National AIDs and STI Control Program (NASCOP) to develop guidelines which are the first step in integrating PrEP as part of national health care services.

“The guidelines on PrEP administration will be launched in June, after which PrEP can now be given in public health facilities. We are in this pilot project making a case for the effectiveness of PrEP. By developing the guidelines through NASCOP, the government is committed to providing PrEP in the long term,” she says.

She adds that partners who are currently supporting the piloting of PrEP will not quit immediately after 12 months explaining that there is a mechanism in place to continue supporting those already enrolled as they work on the long term process.

“Sustainability also means that we have prevented many women from HIV and enrolling for ARVs, the women will only take PrEP during the time they perceive themselves to be at risk. Seeing how women rush for the morning after pill after a weekend of unprotected sex. I believe the same ladies can be convinced to take a pill to prevent HIV, even as they rush to prevent pregnancy,” She concludes.

  • Names have been changed

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