We need to urgently expand access to PrEP

JOHN MUTSAMBI writes:

Despite having the biggest HIV epidemic in the world, South Africa continues to make remarkable progress in the fight against HIV and AIDS. The country has become a hub of HIV prevention research and it has the largest anti-retroviral therapy (ART) programme in the world. On 1 June, 2016, a national programme to provide oral pre-exposure prophylaxis – or PrEP – to sex workers was launched and TB/HIV Care’s eThekwini and Pietermaritzburg sites became two of the first 10 sites in the country to roll out this novel HIV prevention tool. But PrEP advocates are urging for a wider roll-out on the grounds of ethics, cost-effectiveness and to avoid unintentionally encouraging stigma.

At the recently-concluded 21st International AIDS Conference (AIDS 2016) a senior official from the South African National Department of Health (NDoH), complimented TB/HIV Care’s eThekwini site for its sterling work in rolling out PrEP, the pill which, if taken regularly by someone who is HIV negative, helps to prevent that person becoming infected with HIV. To date, this site has initiated a total of 47 clients on PrEP while its sister site in uMgungundlovu, Pietermaritzburg, which started the rollout two weeks later, has also initiated 18 on PrEP.

This pioneering work, makes South Africa a torch bearer in rolling out a programme that could become a model for other countries, particularly those in the sub-Saharan region that have been hard hit by the HIV epidemic.

As PrEP advocates working in collaboration with civil society we welcome this programme and convey special thanks to Dr Aaron Motsoaledi, South Africa’s Minister of Health, for helping to spearhead the push for PrEP implementation.

However, the staged implementation of this HIV prevention method has sparked questions about ethics. One community member said: “Why is the government prioritising sex workers as a key population in the implementation of PrEP when there are other key population groups such as men who have sex with men, people who inject drugs, people in sero-discordant relationships, truckers and prison inmates who are also at high risk of getting HIV?”

And a sex worker remarked: “Some community members call us ‘the drivers of the epidemic’. I think that providing PrEP to sex workers only will further strengthen this stigma.”

These are all voices with concerns that should be listened to. As PrEP advocates, we urge decision-makers in the NDoH to urgently consider expanding access to PrEP to other key population groups, including adolescent girls and young women. We know that this process will not be easy and we are prepared to work very closely with civil society to support the NDoH’s efforts.

As we wait for information from PrEP demonstration projects to inform our decisions about how best to roll out PrEP, we also feel that at this point, we should also learn as we go. Further delays in expanding access to PrEP will result in continued high rates of new infections that could be averted and the associated costs of illness and providing lifetime ARVs. South Africa cannot afford to wait any longer to provide PrEP to those who are vulnerable, no matter who they are.

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