Young women, girls targeted in new HIV prevention method

The drug, meant to protect HIV-negative people from contracting the virus, is targeted at high-risk groups

By DOROTHY OTIENO

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Sexually active young women and girls aged 15 to 24 are among the high-risk groups targeted in the May 4 rollout of a new method meant to protect HIV-negative people from contracting the virus.

The approach, known as pre-exposure prophylaxis (PrEP), involves people at high risk of contracting
HIV taking an antiretroviral pill, Truvada, daily to lower their chances of getting infected.

“By having these medications in the bloodstream, HIV may be unable to establish infection,” said Dr Elizabeth Irungu from the Partners Scale-up Project.

Truvada costs Sh3,700 per month and its generic equivalent is Sh413.

However, the cost of access is higher due to transport cost, consultation and laboratory fees.

CLINICAL TRIALS

The initiative, which is spearheaded by the government in collaboration with partner organisations, has taken years of clinical work, clinical trials and more than 50 demonstration projects in Kenya and around the world to get to the point where a scaled-up implementation is about to be launched.

According to Dr Barbara Mambo from the National Aids and STI Control Programme (Nascop), the research found that with strict daily adherence, PrEP is over 90 per cent effective at preventing HIV infection.

The studies targeted young women and girls, couples where only one partner is infected (sero-discordant) and people who inject drugs, as well as sex workers and men who have sex with men.

The young women and teenage girls are being targeted because of their fast-growing contribution to new HIV infection.

The young females made up a third of the 71,034 Kenyans aged 15 years and above who got infected with HIV in 2015, says the Kenya Aids Response Progress Report 2016.

YOUNG FEMALE ADULTS

A NationNewsplex review of HIV data shows that the young women’s contribution to new incidence of HIV is way above their proportion in the general population of 10 per cent, given that there were 4.5 million young female adults (15-24) in 2015.

According to the Kenya Aids Indicator Survey (KAIS) 2012, with an HIV prevalence of 4.6 per cent, young women and girls are three times more likely to contract the virus than males in the same age group.

Ms Rose Jackline Oyoko, a peer educator with an NGO that runs an HIV project in Migori’s Maryland area, is not surprised by the vulnerability of young people to HIV.

“Most of them are more worried about getting pregnant than contracting HIV,” said Ms Oyoko of the sexually active young women and girls that she counsels.

Her assertions are supported by data, which shows more females than males use condoms during their first sexual encounter but are more likely to abandon them with partners of unknown status as relationships build.

USING CONDOMS

One in four young women, according to the Kenya Demographic and Health Survey 2016, do not know that using condoms during sex and having sex with one uninfected partner can reduce the risk of HIV.

Recently, Ms Oyoko counselled a teen who had been expelled from a mixed boarding school after she was found having sex during night preps.

A common ‘game’ girls in mixed boarding schools play is selecting the most ‘handsome’ boy in their class and then competing for his attention, she said.

“Whoever succeeds gets to have sex with the boy during preps,” Ms Oyoko told Newsplex. “Sometimes multiple girls sleep with the same boy.”

When schools close for the holidays, some girls accompany their boyfriends to their homes for even a week before going to their own homes, she added.

SEX WITHOUT PROTECTION

“Since this is a rural area, where older boys sleep in houses away from the main house, the girl can stay with their boyfriend without his parents knowing,” said Ms Oyoko.

The scary bit is that the youth have sex without protection, with multiple partners, because they have bought into myths about condom use, including the claim that sex is less fun with condoms and causes stomach-ache and other reactions.

According to the latest KAIS, only 28 per cent of women aged 15 to 64 in a relationship with a non-cohabiting girlfriend or boyfriend whose HIV status they did not know reported consistently using condoms during sex.

Use among men in a similar situation was more, at 46 per cent.

According to persons working in HIV support groups, teens in Nairobi from more affluent backgrounds, who are better able to organise sexual encounters, are at higher risk.

POOL PARTIES

Mr Bernard Baridi, the chief executive officer of Blast, a support group of HIV-positive young people, says the teens plan pool parties at their homes when their parents are away or hire a hotel then spread the word through video clips on social media platforms such as Facebook and WhatsApp.

The rule for admission at the parties, which mostly happen during school holidays, is that one cannot take a date, a boyfriend or girlfriend.

“Once at the party, they end up drinking alcohol and having sex,” said Mr Baridi. “Some parents even drop their kids at these parties, believing that partying at a friend’s house is safer than going to a club.

“The equivalent activity for college and university students is white drink parties.

“Some of the young people whom I have counselled say they do it for fun and to relieve stress.

TAKING DRUGS

When you ask them if they know whether they are putting themselves at risk of getting HIV, STIs and pregnancy, they say they take the morning-after pill and post-exposure prophylaxis (PEP).

“They don’t consider the long-term harm of taking the drugs.”

The most difficult to reform, however, say Ms Oyoko and Mr Baridi, are young women who rely on ‘sponsors’ (older men) for financial support.

“They ask who will pay for their basics, clothing, spending money and accommodation if they demand that the older men use condoms,” Mr Baridi told Newsplex.

KAIS showed that children educate themselves about sex from the most ill-informed sources — their peers, films and the internet — with devastating consequences.

BEAR BRUNT

But even as young people increasingly bear the brunt of HIV, KAIS found that only one out of five children aged 10 to 14 said their source of information about HIV was their parent or guardian — the same ratio as those who said it was a friend.

Nine in 10 of the children in the age bracket said they got their information about HIV from school or teachers.

Mr Baridi says parents, teachers and religious leaders have failed young people and need to wake up.

“Most of the teens say that ‘discussions’ on sex with their parents usually boil down to threats like, ‘If you have sex you will get pregnant and I will throw you out’,” says Mr Baridi. “Then they move on to academic performance.”

Said Dr Mambo: “PrEP is not for people who already have HIV; these people need full treatment.”

INJECT DRUGS

PrEp is also ideal for couples where only one person is infected (sero-discordant), especially those who are trying to conceive, sex workers, people who inject drugs and men who have sex with men, said Dr Mambo.

She added that it is important that PrEP is offered as part of a combination package of prevention initiatives such as condoms.

Almost five per cent of married and cohabiting couples are HIV discordant, according to KAIS. More than a quarter — or 27 per cent — of women did not know that their male partner was HIV-positive while a greater percentage of men — 42 per cent — did not know their female partner was HIV-positive.

Moreover, only a quarter reported consistent condom use and that their HIV-infected partners were on antiretroviral treatment (ART).

VIRALLY SUPRESSED

Just slightly more than half (56 per cent) of HIV-positive partners were virally suppressed.

Several studies have shown that effective ART dramatically lowers the risk of onward HIV transmission by suppressing viral load.

Putting PrEp and treatment together may fill any gaps that could occur if a person has recently started ART and not yet achieved an undetectable viral load.

In this strategy, PrEP serves as a “bridge” until treatment is fully effective.

Dr Irungu said once treatment is fully effective, PrEP can be discontinued. The same happens when a person on PrEP becomes HIV-positive, she added.

NATIONAL PREVALENCE

Almost a third of female sex workers and 18 per cent of people who inject drugs and men who have sex with men are HIV-positive.

This is way beyond the national prevalence of 5.6 per cent. The PrEp strategy, therefore, also targets these groups.

Dr Mambo said Kenya’s HIV epidemic is concentrated in several counties, which would also benefit most from PrEP.

However, PrEP does not protect one from other sexually transmitted infections or pregnancy and is not a cure for HIV, she added.