Reck­less re­port­ing in­creases HIV risk

CityPress - - Voices -

Keletso Mako­fane, MPH MSM tech­ni­cal ad­viser: The Anova Health In­sti­tute Mem­ber: World Health Or­gan­i­sa­tion Civil So­ci­ety Ref­er­ence Group on HIV I was alarmed to read the ar­ti­cle ti­tled Play­ing with fire (City Press, March 5 2017) on pre-ex­po­sure pro­phy­laxis (PrEP) among gay men. It makes the claim that “reck­less sex­ual be­hav­iour among gay teens and men” is be­ing fu­elled by the in­creas­ing use of PrEP. This claim rests on a con­cep­tual mis­un­der­stand­ing and some fac­tual er­rors.

The con­cep­tual mis­un­der­stand­ing is to equate sex with­out a con­dom among peo­ple who are on PrEP with “reck­less­ness”. Ac­cess­ing PrEP takes plan­ning and re­sources.

In a con­text where many doc­tors are still un­in­formed about ba­sic sex­ual health for gay men, never mind PrEP, it takes courage for gay men to bring it up with their doc­tors and make plans to ac­cess it.

Ac­cess­ing PrEP means one must go for reg­u­lar HIV test­ing (you can only be on PrEP if you are HIV-neg­a­tive). A per­son who is dili­gent and coura­geous in pro­tect­ing their health is hardly “reck­less”.

Fur­ther, there has been a bevy of stud­ies that show that PrEP is pro­tec­tive against HIV with or with­out con­doms, and that if some­one is HIV-pos­i­tive and vi­ro­log­i­cally sup­pressed, they do not trans­mit HIV. The con­cept of “reck­less­ness” must change as we learn new ways of pre­vent­ing HIV trans­mis­sion.

The claim that there is a spike in sex­u­ally trans­mit­ted in­fec­tions (STIs) among young peo­ple on PrEP has no ba­sis in data.

In South Africa, there are not enough peo­ple on PrEP to draw that con­clu­sion (or at least not enough peo­ple whose STI bur­den we can mea­sure). Fur­ther, in set­tings where STIs among gay men are on the in­crease, it is not clear that this in­crease is at­trib­ut­able to ex­pand­ing PrEP use, or whether STIs are in­creas­ing for other rea­sons.

Large-scale PrEP tri­als cer­tainly have not found that peo­ple who are on PrEP in­crease their sex­ual risk. On the con­trary, it has been the peo­ple who know that they are al­ready at higher risk for HIV who have opted to take PrEP to man­age their risk.

Fi­nally, we make a crit­i­cal omis­sion when we speak about a po­ten­tial spike in STIs with­out speak­ing about the fact that the STIs in ques­tion are largely cur­able, or at least much eas­ier to man­age than HIV.

If, as a by-prod­uct of pro­tect­ing peo­ple against HIV in­fec­tion, we end up with more cases of cur­able STIs, we would still be hav­ing a pos­i­tive ef­fect on peo­ple’s lives.

Con­tract­ing HIV is no longer a death sen­tence, but it is a chronic con­di­tion that re­quires strict ad­her­ence to the regime of tak­ing daily med­i­ca­tion and mak­ing reg­u­lar clinic vis­its for the rest of one’s life.

In a time when the global HIV epi­demic is rag­ing among gay and bi­sex­ual men, it is reck­less to stig­ma­tise new preven­tion tech­nolo­gies and the users of th­ese tech­nolo­gies.

It is es­pe­cially reck­less in the South African con­text to spread mis­in­for­ma­tion about HIV.

It is not gay men on PrEP who are play­ing with fire, it is the au­thor of this ar­ti­cle and the ed­i­tors who ap­proved it.

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