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Comment
Spread the word on HIV drug
PrEP is an effective tool for eliminating HIV, but stigma and ignorance
are hindering its uptake, says Doug Johnson
I
N 2016, the UN issued its
“Political Declaration on
Ending AIDS”, aiming to rid
the world of the HIV epidemic
by 2030. One target for 2020 was
to reduce new HIV infections to
fewer than 500,000 by, among
other things, reaching 3 million
at-risk people with pre-exposure
prophylaxis (PrEP) by this year.
But this target is set to be missed
by a country mile, hindering
the global fight.
PrEP is a pill containing
two chemicals, tenofovir and
emtricitabine, that kills HIV
before it can infect a person.
It can be taken either daily, or at
specific times prior to sex, and
has been shown to help protect
many groups particularly at risk
of transmission, including sex
workers, intravenous drug users
and men who have sex with men.
PrEP is both highly effective and
works where the use of condoms
and other prevention methods
may not, for example in cases of
sexual assault or needle sharing.
It also empowers women,
particularly important in sub-
Saharan Africa where over half
of new adult infections are among
women, rising to two-thirds of
new infections in young people.
Yet PrEP uptake remains
underwhelming. In 2018, only
380,000 people were on the
medication worldwide. Half
of them were in the US, and
very few in areas with high HIV
prevalence, for example in eastern
JOSIE FORD
and southern Africa. “It’s very
patchy,” says Rosalind Coleman,
Culture
The books, games,
films and events on
the way in 2020 p24
a PrEP consultant with the Joint
UN Programme on HIV/AIDS
(UNAIDS). Although every person
who regularly takes PrEP helps
stem the spread of the virus, “it’s
nowhere near enough if we want
PrEP to have an impact on the HIV
epidemic”, she says.
Last month, UNAIDS published
a global survey of barriers to PrEP
access. Of 69 countries reporting
PrEP availability, only 13 said
there was no barrier. For the rest,
high cost and limited accessibility
of treatment were the most
frequently cited problems.
Stigmatisation of at-risk groups
plays its part too. The survey
revealed that in some countries
Aperture
The Byzantine beauty
of a magnified
surgical stitch p28
possession of PrEP can even be
used as evidence of sex work or
other criminalised sexual activity.
“The systems often actually screen
out or exclude exactly the people
who need PrEP,” says Mitchell
Warren of AVAC, an HIV prevention
charity based in New York.
Combating prejudice against
PrEP users will take time, as will
overcoming the disinclination
of some at-risk people to take it –
because taking a daily pill doesn’t
fit with their lifestyle, for example,
or they don’t want a constant
reminder that they are at risk.
Meanwhile, there is a more
mundane barrier. There have
been decades of campaigns about
condom use and other safe sex
practices to lower HIV rates, but
PrEP is a newcomer struggling
to catch up. Awareness of how
it works, and who should take it,
remains low. “PrEP got developed,”
says Warren. “Science showed that
it worked, but most people in the
world don’t know it exists.”
Where that barrier can be
broken down, change can happen
fast. In South Africa, a concerted
education effort has seen the
country recently exceed its target
for PrEP uptake, with an estimated
35,000 people using it. Young
people at higher risk of HIV
infection were particularly eager,
says Linda-Gail Bekker of the
Desmond Tutu HIV Centre at the
University of Cape Town, who
helped run clinical trials on PrEP
in South Africa. “Once people
wrap their heads around it and
they recognise that they are going
to be able to be in charge of their
own destiny, as it were – this is
what we’re really hearing from
young women – they do get very
excited,” she says.
Easier, more convenient
methods of using PrEP are also
being developed, including a
version that needs to be taken
only monthly. But with just a
decade left to meet the UN’s goals,
there is one thing above all that
must be spread: awareness that
PrEP exists, and that it works. ❚
Doug Johnson is a
journalist based in
Montreal, Canada
4 January 2020 | New Scientist | 19