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Pre-exposure prophylaxis: A preventative solution to HIV.
For people who are at very high risk for HIV, PrEP can considerably reduce the risk of HIV infection. Find out more about this preventative solution to HIV.
What is pre-exposure prophylaxis?
From a young age, we are taught to practise safe sex to prevent unwanted pregnancies and contracting and spreading sexually transmittable diseases (STDs). Condoms, for many years, have been promoted as the safest option, offering on average a 70%-97% success rate against STDs, HIV infection and pregnancy. In the USA in 2012 the FDA introduced a new player into the world of sexual health: Truvada (tenofovir/emtricitabine) was approved and released into the market as the first drug to reduce the risk of HIV infection in uninfected individuals. South Africa did not take long to follow suit and approved the medication in 2015 after a two-year application by Aspen.
Pre-exposure prophylaxis (or PrEP) is a prevention method created for people with a very high risk for contracting HIV, and the best known available drug for this treatment is Truvada. Truvada is taken daily to lower one’s chance of getting infected with the HI virus. Previously, Truvada was used in combination with another antiretroviral (ARV) as a treatment for HIV in South Africa‚ but had not been licensed legally for the sole purpose of prevention. South Africa is now one of 20 countries with PrEP demonstration projects, along with other African countries such as Uganda, Kenya and Zimbabwe.
Many in the medical sector have challenged the new drug with much controversy and criticism. Questions have been raised about the true effectiveness of the product as well as participants’ commitment to taking the drug correctly and consistently and whether the drug promotes promiscuity. Professor Linda Gail Bekker, deputy director of the Desmond Tutu HIV Foundation, has campaigned for the licensing of the drug as a measure of prevention under the belief that it is a cheaper and better way to prevent HIV infection especially in high-risk groups such as young women‚ sex workers and gay and bisexual men.
South Africa is widely affected by HIV and has one of the largest HIV profiles in the world. Deputy President Cyril Ramaphosa announced earlier this year at a National Health Workers HIV Plan that 72% of sex workers in Johannesburg are understood to be HIV positive. These statistics are very concerning and efforts such as PrEP and Truvada hope to combat this and ultimately slow down the transmission rate.
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Prep has also been recommended to:
- People who are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner
- People who are not in a mutually monogamous relationship with a partner who recently tested HIV-negative
- Gay or bisexual men who have had anal sex without using a condom or been diagnosed with an STD in the past 6 months
- Heterosexual men and women who do not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).
For people who are at very high risk for HIV, PrEP can considerably reduce the risk of HIV infection if taken daily. Daily PrEP use can lower the risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%. Although thus far PrEP methods have yielded positive results, it is recommended to continue using a condom as PrEP does not protect against other sexually transmitted diseases such as gonorrhoea and chlamydia.
PrEP methods are also not proven to be 100% effective. In February this year a gay man, while seemingly adhering to the recommended daily regimen of Truvada as a PrEP method, tested positive for HIV. Experts have said that this case is a concern but should remain rare.
Taking Truvada consistently and correctly as PrEP prevents the reproduction of HIV – if exposure occurs, the virus is unable to establish itself in a person’s body. Additional strategies are also available, which may be used in conjunction with PrEP, to reduce risk even further.
In South Africa, Truvada had previously been used by doctors who prescribed it “off label”, (relating to the prescription of a drug for a condition other than that for which it has been officially approved). The drug is now legally registered for prevention and so prescribing it to more people at high risk of HIV has been made easier. Truvada is not currently freely available as prevention in the state sector. It is also not clear yet if medical aids will pay for its use as prevention and who will be eligible for the drug.
The need to address the next step of how the Department of Health will make Truvada available to those most at risk for HIV infection has been raised by many. The ability to slow down the spread of HIV significantly, however, would mean praiseworthy news for the future of South Africa.
We all have questions.
Below are some of the answers to the most common questions that you need to know.
What is usually the first sign of HIV?
After getting infected with HIV, most patients only experience moderate flu-like symptoms. Typically, the illness is sudden in onset and is characterised by fever, swelling of the lymph glands, a measles-like rash all over the body and ulcers in the mouth and sometimes on the genitalia.
What are the 4 stages of HIV?
- Stage 1: Infection – Exposure to infected bodily fluids.
- Stage 2: Asymptomatic – HIV quickly spreads and the patient becomes seropositive for HIV antibodies.
- Stage 3: Symptomatic – The immune system is now engaged in a constant battle with the rapidly replicating virus.
- Stage 4: AIDS – At this stage, the patient’s CD4+ count is 200 cells per mm3 or less.
How soon can HIV be detected by a blood test?
No test can detect HIV immediately after infection. The time between initial infection and a detectable viral load is called the window period. It can take anywhere from 2-12 weeks to after exposure detect whether you are HIV-positive or not, depending on which testing method is used.
How long does it take to show symptoms of HIV?
Following initial infection, there is a period of intense, unchecked viral replication that occurs. It usually takes two to four weeks after infection and can last about one to two weeks, after which there tends to be a slight recovery, and the infected individual is considered to be seropositive for HIV antibodies.
How is HIV transmitted?
HIV is transmitted from one person to another through the exchange of body fluids. The main method of transmission in South Africa is through unprotected sexual activity.
Does HIV test affect life insurance?
Being HIV-positive can affect standard life insurance policies, particularly if your status changes from HIV-negative to HIV-positive within a particular age range. That’s why AllLife covers all lives. Your HIV status doesn’t prevent you from getting cover with us.
Can HIV-positive women have children?
Yes, HIV-positive women can enjoy healthy pregnancies and give birth to healthy HIV-negative babies. Through the Prevention of Mother to Child Transmission (PMTCT) programme has been highly effective in reducing transmission risk to under 1%.
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