In a world where 36.7 million people are living with HIV, drugs that both effectively treat and prevent the infection are urgently needed.
A small blue pill could be the answer. Uniting the groups most at risk of contracting HIV — gay men in the UK or the USA to poor communities in South Africa or Uganda — a breakthrough drug is gaining ground.
Pre-Exposure Prophylaxis (known as PrEP for short) is an innovative form of medication that has already proven to be highly effective. The formula is simple. Everyday, people at risk of contracting HIV take a pill designed to fight the symptoms of the virus. The drug works in people who do not have the virus by preventing the virus’s ability to multiply and attack the blood’s ‘T-cells’ — a type of white blood cell essential to the body’s immune system.
Studies show that it reduces the risk of infection by 90%, providing adequate protection against the disease during sex with an HIV-positive partner.
Since it was first approved in 2012 by the US Food and Drug Association (FDA), PrEP has proven to be more effective in preventing infection than traditional forms of protection, like condoms — and puts power firmly back in the hands of those vulnerable to contracting the disease.
18-year-old Catherine Msimango, featured in an NPR profile of the new drug, is a case in point. Growing up in Soweto, a South African township with a population of 1.3 million, she has lost close relatives to HIV and seen the devastation it causes to people’s lives and families.
“I know the experience of HIV,” she said in the interview. “I don’t want to go there.”
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Along with other teenagers in her community, she signed up to take part in a pilot programme to test PrEP. As a sexually active young woman, she believes the drug has enabled her to retain control of her body. Unlike depending on a condom as the only source of protection, she can now protect herself from contracting HIV without requiring her boyfriend’s permission.
"It's all about my safety because I don't know what he does when I'm not around," she said. "If he doesn't want to use protection [a condom], I know that I'm safe from the pill."
The power dynamics in communities like Soweto often leave young girls and women vulnerable to older men when it comes to sex. While tackling HIV/AIDS requires extensive public education plans to ensure both parties understand their responsibility in preventing transmission of the virus, PrEP restores agency to girls like Catherine in high-risk communities.
"Thirty years into this epidemic, it's clear that condoms are not the solution for everyone," said Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town.
Travel thousands of miles across the world and it’s a similar story. In London, 1 in 8 gay men live with HIV. As part of a clinical trial called Proud, 500 homosexual men in England have taken PrEP on a daily basis for over a year, and the results have been overwhelmingly positive. One participant, Harry, argues that it has made sex safer for him, and calls for it to be available more widely.
Critics of PrEP argue that it could encourage people to engage in unsafe sex — although PrEP can prevent the spread of HIV without the need for a condom, it cannot protect against other STIs.
However, its effectiveness in preventing new cases of HIV has been proven. The drug is currently at the centre of a legal battle in the UK, as charities campaign for PrEP to be more widely available on the NHS.
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Innovative steps in preventing new infections are crucial in creating a world without HIV and AIDS. A report released by UNAIDS in July 2016 highlighted the urgent need to scale up HIV prevention amongst adults. The Prevention Gap report revealed that although progress had been made in reducing new HIV infections amongst children, the decline in new HIV infections amongst adults had stalled over the last five years. In some parts of the world, including the Middle East and North Africa, the number of new infections has even risen.
“We are sounding the alarm,” said Michel Sidibé, executive director of UNAIDS. “The power of prevention is not being realized. If there is a resurgence in new HIV infections now, the epidemic will become impossible to control. The world needs to take urgent and immediate action to close the prevention gap.”