Lessons in helping African women avoid HIV
Videos show how a nonprofit tries to tackle a difficult mission
Six short videos were released this past week describing how a Kenyan nonprofit organization tackles one of Africa’s toughest missions: helping young women protect themselves against HIV.
The videos, by LVCT Health and posted on the PrEPWatch website, are funded by U.S. foreign aid and the Bill and Melinda Gates Foundation in an effort to get PrEP — pre-exposure prophylaxis — to African women.
Even though PrEP, in the form of a pill containing the anti-HIV drug tenofovir, is more than 99 percent effective when taken every day, it has been an uphill battle even to get gay American men to embrace it. (In the United States, the pill is sold as Truvada.)
South Africa and Kenya have both adopted it, but donors worry that it will be even harder for African women to accept, for many cultural reasons.
There is still no vaccine. Abstinence, fidelity and both male and female condoms have failed to turn the tide despite 30 years of often controversial publicity campaigns.
Vaginal gels and rings releasing HIV-killing drugs have failed in clinical trials — not because they don’t work, but because many participants threw them away. In interviews, the women said they feared being beaten by their husbands or boyfriends, or being gossiped about by neighbors who would accuse them of being promiscuous.
Protecting women is harder for physical reasons, too. Tenofovir reaches much higher concentrations in rectal tissue than in vaginal walls; a gay man can miss three doses a week and still be 96 percent protected, but a woman who misses more than one dose becomes virtually defenseless.
The videos, created to help other African nonprofits roll out PrEP, describe how counselors from LVCT tackled various obstacles. For example, because young women are afraid to be seen entering HIV clinics, testers found nonmedical places like schools in which to explain PrEP to small groups.
Perhaps most important, because even infected men sometimes forbid their wives or girlfriends to use PrEP, thinking it promotes promiscuity, LVCT had male counselors visit village chiefs and meet with the husbands. The best tactic with a stubborn man, one counselor said, was to ask who would raise his children if his wife died of AIDS.