One-pill-a-day to prevent HIV: A doctor’s personal experience as a client
THE FIRST time I was offered the one-pill-a-day to prevent HIV was while working at a doctor’s office in Washington, DC, USA. The 2019 Annual Epidemiology and Surveillance Report of the District of Columbia, USA, reported an HIV prevalence of 1.8 per cent, with an estimated 12,400 persons living with HIV. One out of every 25 black men in DC is living with HIV, compared to one in 1,000 white women. In Jamaica, there are approximately 30,000 persons living with HIV, and HIV prevalence is 1.3 per cent for persons 15 to 49 years old. The Joint United Nations Programme on HIV/AIDS estimates 1,500 new infections in Jamaica annually.
WHO SHOULD GET THE HIV PREVENTION PILL?
Fewer sexual partners, correct condom use, treatment of sexually transmitted infections (STIs), HIV testing, and treatment of persons with HIV to suppress the virus are essential to limiting HIV spread. Other STIs weaken the natural barrier of the skin or sexual organs, increasing the chance of infection with HIV. Much of the increased risk for HIV arises from the scorn with which some persons are treated by society because they do not fit an expected gender role, come from a particular socioeconomic group, or are targeted for criminalisation.
Discrimination prevents persons from freely accessing sexual health knowledge and prevention services. They are forced to live aspects of their lives in secrecy, putting them at risk for violence, with little or no recourse for protection from the law. Samesex-loving persons, persons who live as a gender different from their sex at birth, and persons involved in sex work (and their clients) are examples of persons who face marginalisation and a significantly greater chance of HIV infection. Young females who are dependent on older men may have little power to negotiate condom use due to fear of violence, which increases their vulnerability to HIV.
Partners of persons living with HIV in whom the virus is not suppressed with therapeutic antiHIV medicines are at risk. Individuals at risk for HIV infection can benefit from a prevention pill, in addition to condoms and risk reduction.
DOES THE HIV PREVENTION PILL WORK?
In the ‘iPrex’ study published in 2010, the risk of HIV infection was 92 per cent lower in persons in whom the medications were detected, compared to persons who had little or no medicine in their bodies. Overall, the prevention pill reduced the risk of HIV among same-sex-loving men by nearly half (47 per cent), compared to persons who received an empty pill with no active drug. Published in 2022 in the British Medical Journal Open Access, a review of 15 clinical trials revealed protection of 75 per cent. Protection was 86 per cent when medication compliance was 80 per cent or more, compared to protection of 45 per cent when compliance fell below 80 per cent. Protection was better for men, both heterosexual and nonheterosexual, compared to women. A more real-world study in France, using their national health data system and published in the Lancet Public Health in 2022, showed an effectiveness of 60 per cent among men overall, rising to 93 per cent effectiveness for those who took 75 per cent or more of their doses.With approval from the US Food and Drug Administration in 2021, an injectable HIV-prevention medicine given every two months has also been in use. Effectiveness is dependent on how well an individual sticks to these medicines.
SIDE EFFECTS
At first, I felt like I wanted to vomit. About one in 10 persons in clinical trials experience nausea. Because the HIV-prevention pill is also active against hepatitis, starting and stopping the medication may potentially worsen viral hepatitis that affects the liver, and so testing for hepatitis is important. The HIV-prevention pill can also affect the kidneys, necessitating regular health checks. In clinical trials, kidney abnormalities have tended to be non-progressive and reversible. An initial conversation with a healthcare provider could just be around general health and whether this prevention pill may be right for the individual. There may also be the perception that because persons are on a prevention pill, they should stop using other prevention methods.The HIV-prevention pill does not protect against other STIs nor pregnancy.
USE ALL AVAILABLE TOOLS
I think of persons who will get HIV over the coming months. An HIV-prevention medication is a welcome addition to other prevention approaches. If we, indeed, expect 1,500 new infections each year in Jamaica, we need all the help we can get.
WHERE TO GET THE HIV-PREVENTION PILL
The HIV-prevention pill can be accessed from Jamaica AIDS Support for Life at 876-925-0021 or 876-9696597; or the Centre for HIV/AIDS Research, Education and Services, The University of the West Indies, at 876-977-6921 or 876-379-6848.