PrEP is an everyday pill that an HIV negative person can take to prevent getting HIV. Consistent use is essential for protection. Since PrEP is still a relatively new advancement in HIV prevention technology, there are still a lot of concerns and misconceptions around it. Fortunately, there has been a flurry of research in the drug and Prof Linda-Gail Bekker, COO of the Desmond Tutu HIV Foundation, aims to dispel some common myths and concerns around it.
PrEP while Pregnant, Lactating and Breastfeeding
HIV positive people can now live full lives, which includes having HIV negative children. There have been concerns about HIV transmission from mother to infant, however, the research is indicating that taking PrEP during all stages of mother to infant contact is safe.
PrEP is advised during conception when there is a high-risk of the mother becoming HIV-positive. Transmission can occur during pregnancy because not everyone tests regularly while pregnant and seroconversion (the period when the HIV antibodies develop and become detectable) takes time. PrEP protects the mother from HIV, and therefore also protects an unborn baby. Additionally, it is difficult for the compound in PrEP (tenofovir) to move into the breast milk and is safe to take while breastfeeding.
Time to Protection
The controversy here is how long a patient should take PrEP before they are protected. Some parties believe everyone should wait 21 days, whereas other think a week is sufficient. These data arise from animal studies, and there are models that support the one-week waiting period, but nothing conclusive has been shown in humans yet.
How long does someone need to take PrEP for until they are ready for sexual intercourse? Bekker advised that everyone should wait 21 days, especially if they are trying to get pregnant. This gives the drug the maximum time required to give the highest possible protection. However, a week may be the maximum time some populations will wait; adolescents, for example. in the case of populations who are less likely to wait (adolescents, for example).
‘Just’ a Medical Intervention?
PrEP is more than just a drug. It’s a sensual product that can bring intimacy back into the bedroom. Instead of a medical intervention, it should be marketed as a lifestyle intervention. It puts women who feel unable to negotiate condom-use back in charge of their sexual health, and it dulls the anxiety of contracting HIV in the bedroom.
The PrEP4Love campaign (below) is a social marketing campaign showing real couples catching desire in the bedroom, safe from the threat of transmitting HIV with the proper use of PrEP. It is campaigns like this that turn PrEP into a tool for intimacy.
The tough questions need to be asked: will PrEP-users stop using condoms, putting themselves at risk of other STIs and unwanted pregnancy? Some statistics attribute PrEP use to an increase in STI transmission. However, STIs and condomless sex have existed since before PrEP existed. These studies are starting to closely analyse a problem that has existed for a long time.
PrEP should be considered part of an HIV prevention package. With consistent use, it protects against HIV, but it can’t protect against other STIs and it is not a contraceptive.
Bekker summarised that at the moment, a month’s worth of PrEP is predicted to cost R260. This figure doesn’t include HIV tests or doctors fees. This estimate, whilst based on data, is not a ‘real world’ study and is derived from PrEP trials. It is predicted to change as PrEP is rolled out in South Africa.
It must be emphasised that PrEP is not a solution for life: it is a prevention method that one takes when at highest risk of infection.
This research meeting we were fortunate to have Karen Dominguez and Prof Linda-Gail Bekker speaking on their respective research projects. Dominguez spoke about the Sibanye study, which evaluated how men who have sex with men (MSM) respond to different HIV interventions. Bekker summarised the latest research around the HIV prevention drug, Pre Exposure Prophylaxis or PrEP, including busting common myths or misconceptions about the drug.
Written by Caroline Reid