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THIRTY years since the first reported case of AIDS, experts have found that health campaigns to stop the spread of HIV were overlooking the power of libido, pleasure and perceptions that condoms form a barrier to intimacy. Although in the early days, the use of safe-sex prevention messages such as “use a condom every time” worked to ensure significant reductions in new infections till up to the 2000s, by the time medical treatments started to take effect in the ’90s, it became clear people were thinking of strategies to enjoy safe, unprotected sex and so the need for multiple prevention strategies.
Until recently, it has been assumed there is no safe option other than condoms for HIV prevention. Nevertheless new research into the preventive benefits of HIV treatment (antiretroviral therapy) is set to change the way people think about HIV prevention and safer sex advice. There is growing evidence that AIDS drugs used to treat people who are already sick with HIV can also be used to prevent infection among heterosexual men and women, according to the results of two studies that involved couples in Kenya, Uganda and Botswana.
HIV treatment works by reducing the level of HIV in the body (the viral load) to such an extent that a person’s infectiousness is almost zero (clinically referred to as “undetectable”). A big effect of this, in addition to keeping the person well, is that the risk of transmitting HIV to another person is significantly reduced.
The studies, which are offering a new hope for a medical shield against HIV infection someday, found that daily AIDS pills in heterosexual men and women reduced infection rates by at least 62 per cent when compared with placebo (fake or dummy pill).
The larger of the two studies examined 4,758 couples in Kenya and Uganda in which one partner was HIV-positive and the other was negative. Those negative partners taking Gilead Sciences Inc’s tenofovir, or Viread, had on average 62 per cent fewer infections. For couples on Truvada, another Gilead drug combining tenofovir and emtricitabine, the infection risk was reduced by an estimated 73 per cent in the study. The second study, involving just over 1,200 sexually active men and women in Botswana, found those on daily Truvada reduced their risk of HIV infection by 62.6 per cent.
The idea of using antiretroviral drugs by uninfected people to prevent HIV infection or pre-exposure prophylaxis (PrEP) has gained footing in the past year, following results of other research showing a reduction in contracting HIV among uninfected gay men taking AIDS drugs and among women who applied a vaginal gel containing an AIDS drug. Also, infected people treated with the drugs were shown to be 96 per cent less likely to transmit HIV than patients not yet on therapy. And a few years ago, circumcision was proven to reduce the chance that a man would acquire HIV.
The standard treatment of HIV infection is three or more antiretroviral drugs taken daily for life once the virus has begun to measurably damage the immune system. When used for “pre-exposure prophylaxis” (PrEP) one or two drugs are taken daily.
HIV cannot be transmitted sexually if the HIV-positive individual takes antiretroviral therapy consistently and as prescribed and is regularly followed by his/her doctor; the viral load is ‘undetectable’ and has been so for at least six months and the HIV-positive individual does not have any Sexually transmitted infections (STIs).
This is new results further establish the effectiveness of ARV use as a prevention tool. According to Dr Morenike Ukpong, the coordinator of the Nigerian HIV Vaccine and Microbicides Advocacy Society (NHVMAS), “it further corroborated the possible use of ARV treatment in PLHIV to reduce new HIV infection incidence.“
NHVMAS is a nongovernmental organisation concerned about active engagement of Nigeria and Nigerians in New HIV prevention technology (NPT) research and development so as to ensure timely access of its citizens to these products.
However, there are several challenges to the use of ARV in the prevention of HIV transmission among couples in Nigeria. STIs in the body can make HIV levels increase tremendously, which seriously compromises the effects of treatment as prevention and significantly increases risk of transmissionss. According to Dr Ukpong, “management of sexually transmitted infections is poor in Nigeria, so further worsen the chances of getting HIV. Worst still, many people with STIs are not aware of these infections.”
Given that the long term consequences of a prolonged use of HIV as a means of prevention is yet to be determined by any study, Dr Ukpong emphasised that it was not time that individuals throw away condoms altogether. According to her, condoms are still the best protection against other sexually transmitted infections, so any couple wanting to rely on treatment rather than condoms to prevent HIV transmission must be confident they are both STI free and monogamous.
Certainly from several people’s experiences, HIV treatment as prevention is not some “quick fix”. There remain complex issues of love and trust to negotiate, as well as unlearning the internalised stigma and fear around HIV, which people have lived with for years.
Also, a large number of people living with HIV have not been diagnosed – and therefore are not on treatment. So with the exception of those in completely monogamous (and honest) relationships, the message is still “use condoms”.
In addition, whether or not women in Africa or anywhere else can be placed on drugs to prevent infection is yet to be determined because this would be too expensive and the drugs can cause side effects. But, it might be cost-effective to target high-risk women, such as sex workers.
However, researchers and advocates believe that there is the need to understand in which populations to apply them and how to combine them with other prevention tools, such as counseling and HIV testing in the fight against HIV.