Pre-exposure prophylaxis (PrEP) normally comes as a daily course of antiretroviral drugs (ARVs) that are taken orally and can protect HIV-negative people from HIV before potential exposure to the virus.
Scientific evidence after more than 15 trials of oral PrEP shows that when taken consistently and correctly, PrEP reduces the chances of HIV infection to near-zero. This has led to the description of PrEP as a ‘game changer’ for HIV prevention.
While it is an effective protection against HIV, PrEP does not provide protection against other sexually transmitted infections (STIs) and blood-borne illnesses such as Hepatitis C, syphilis, and gonorrhoea.
PrEP has been shown to reduce the risk of HIV infection from unprotected sex by over 90%, and from injecting drugs by more than 70%. These statistics include individuals with lower adherence levels so the actual level of protection for those fully adhering is higher and near 100%.
In Africa, East and Southern Africa are the most affected by HIV, with over 700,000 new infections in 2019. Women are disproportionately affected, as demonstrated by 2018 HIV prevalence rates among young women (15–24 years), which are more than double the rates seen among young men.
Some of the main challenges confronting the rollout of oral PrEP include difficulties in translating policy into practice as well as ineffective use among populations at risk of acquiring HIV in sub-Saharan Africa .
PrEP use among adolescent girls and young women (AGYW), FSW and other vulnerable key populations in particular have been slowed down by barriers including low perceived HIV risk, pill burden, limited private storage space, fear of discrimination from family and partners, intimate partner violence, stigma associated with an antiretroviral-based product, as well as negative attitudes among healthcare providers toward adolescent sexuality and PrEP use.
One potential solution for increasing access to oral PrEP is Advocacy.
Advocacy involves the art of promoting public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behaviour of individuals to the behaviour of policy makers whose decisions structure the environment in which people act.
Advocacy addresses the power gap rather than just the information gap. The essence is to push a point-of-view through media coverage that exposes the problem we seek to fix; spotlights a solution we seek to implement; celebrate one of our advocacy allies, while trying to achieve advocacy goals.
The global summary and forecast study, published in The Lancet HIV, analyzed data on the adoption of WHO PrEP recommendation and numbers of PrEP users from 2016-2019 and forecasted numbers of PrEP users through 2023.
According to a consultant for the World Health Organization’s Global HIV, Hepatitis and STI programs, Robin Schaefer, since 2015 when WHO recommended to offer oral PrEP to anyone at substantial risk of HIV as part of combination prevention, global use has increased markedly
The study found that there were 626,000 PrEP users in 77 countries in 2019, after two-thirds of countries (120) had adopted WHO recommendations into national guidelines.
This was a 69% increase from 370,000 PrEP users across 66 countries in 2018, when 30 countries had adopted the recommendations, but fell short of a goal of 3 million oral PrEP users by 2020 set by the UN General Assembly in 2016.
The study projected 900,000 to 1.1 million global PrEP users by the end of 2020 and 2.4 million to 5.3 million PrEP users by the end of 2023.
Preliminary data for 2020 suggests that significant growth in PrEP use continued despite disruptions by COVID-19 in many settings. Therefore, these future scenarios may not be unrealistic, particularly in light of new PrEP products becoming available.”
There are now hundreds of thousands of PrEP users globally, and PrEP can make substantial contributions to the UN declaration of ending AIDS as a public health threat by 2030.
PrEP should be offered to anyone at substantial risk of HIV infection in discrimination- and stigma-free way, and everyone asking for PrEP should be considered for PrEP initiation.
In order for PrEP to be getting out into the African communities of need, Advocacy is key. it is important to have conversations and engage people where they are locally, and not just in clinics or health care settings and understand the structural barriers that prevent people from taking it.