Who would want to start taking antiretroviral drugs (ARVs) when one is HIV negative?
Well, if one is at risk of being infected and wants to prevent oneself from acquiring HIV, the virus that causes AIDS, then you can temporarily be put on ART as part of the combination prevention methods under a system called PrEP or Pre-Exposure Prophylaxis.
Any person at risk of contracting HIV such as sex workers, migrant workers who include defence personnel, long distance drivers, discordant couples who want to have children, etc, can be put on ARVs until such a time that they are no longer at risk of contracting HIV.
Last week, at a Media Science Cafe’ at Zamcom Lodge in Lusaka organised by Zamcom with support from AVAC, Treatment Advocacy and Literacy Campaign (TALC) executive director Felix Mwanza said the use of daily oral pre-exposure prophylaxis (PrEP) was recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches.
Mr Mwanza said PrEP was the use of antiretroviral medication by people who were HIV negative to prevent them from acquiring HIV. He said PrEP trials have taken place in Africa, Asia, Europe, North America and South America and that the trials to date have used TDF-based regimens – either TDF combined with emtricitabine (FTC) or TDF alone. He said Oral PrEP containing TDF can be highly protective for both men and women with:
•      Very low numbers of serious side effects have been seen in
trials of TDF-based PrEP.
•      Adherence and ongoing follow-up with regular HIV testing are essential.
•      People who had high levels of adherence had high levels of protection.
•      Lower adherence was associated with low or no protection
He was worried that the number of adults acquiring HIV is decreasing too slowly, and in some populations it is still rising and additional prevention options are urgently required to respond to unmet prevention needs.
PrEP is intended for people who are at substantial risk of HIV exposure and who do not always use condoms. PrEP can also be used specifically for safer conception.
PrEP is under personal control, it is invisible at the time of sex and the decision to take it is separate from the sex act.
Mr Mwanza summed up his presentation saying:
•      Oral PrEP is an additional HIV prevention option for individuals at substantial risk of HIV exposure that will be effective as part of a comprehensive response t o H I V • PrEP is safe and effective when used correctly and consistently
•      PrEP is not for everybody; it is not forever; and it does not replace condoms. Rather, PrEP is an additional option for that individual at risk of HIV and should be able to choose
•      PrEP can contribute to decreasing fear and stigma of HIV and to encouraging shared sexual decision-making
•      People who use PrEP should take it every day and return to their health-care provider for repeat testing for HIV, safety monitoring, prescription refills and risk and adherence follow-up.
He, however, called for political will and appropriate support from organisations such as PEPFAR if PrEP was to be administered effectively in Zambia saying so far, PEPFAR had not shown any commitment to roll out PrEP in countries like Zambia.
Earlier, Senior Health Advisor at USAID George Sinyangwe who was representing PEPFAR, said providing PrEP to individuals who at higher risk to contract HIV is part of the 2015 World Health Organisation (WHO) guidelines which also say that any person diagnosed with HIV, regardless of CD4 count, should be placed on treatment.
The anticipated results of these guidelines at global level includes averting 28 million new infections by the year 2030, avert 21 million AIDS related deaths and there would be substantial savings on HIV management. Dr Sinyangwe explained the importance of CD4 and viral load in the management of HIV and that the American organization would certainly support PrEP.
Network of Zambian people Living with HIV (NZP+) Executive Director Eunice Sinyemu, said during the same discussion that PEPFAR has however, picked some aspects of HIV prevention rather than approach the issue wholly and wondered how the organisation would effectively support PrEP in Zambia, a position that was supported by the TALCchief Mr Mwanza.
Ms Sinyemu said sex in Zambia is perceived to be a cultural issue but emphasised that testing for HIV should not be forced on anyone. She said what should be mandatory should be the transmission of information on the importance of voluntary counseling and testing(VCT).
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