Many voices equal a loud shout!!! Hello Everyone, please ask your healthcare administrators to bring this miracle drug to your country! We can make a change and stop HIV! – Steve Pejman Dee Founder of Jobs-Liberia.
Pre-Exposure Prophylaxis (PrEP): Pre-exposure prophylaxis (or PrEP) is a way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.
When taken daily, PrEP is highly effective for preventing HIV. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily. Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily. PrEP is much less effective if it is not taken consistently.
As PrEP only protects against HIV, condoms are important for the protection against other STDs. Condoms are also an important prevention strategy if PrEP is not taken consistently.
Pre-exposure prophylaxis (PrEP) normally comes in the form of 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.
More than 15 trials of oral PrEP have shown that, when taken consistently and correctly, PrEP is very effective and reduces the chances of HIV infection to near-zero.1 2 3 4 This has led some to describe PrEP as a ‘game changer’ for HIV prevention.5 6 7
While PrEP can provide very effective protection against HIV, it does not provide protection against other sexually transmitted infections (STIs) and blood-borne illnesses such as Hepatitis C, syphilis, and gonorrhoea. The effectiveness of PrEP is closely linked to adherence – if someone taking PrEP regularly misses some daily doses, their risk of HIV infection will increase substantially. It is therefore important that any programme offering PrEP provides it as part of a combination package of prevention initiatives, based on an individual’s circumstances – with support and advice on the importance of PrEP adherence.
In 2015, recognising that PrEP has potential population-wide benefits, the World Health Organization (WHO) released new guidelines recommending that PrEP should be offered as a choice to people who are at substantial risk of HIV infection as part of a combination HIV prevention programme.
Previously, PrEP was only recommended for certain key affected populations such as sex workers, men who have sex with men (sometimes referred to asMSM), people who inject drugs (sometimes referred to as PWID).9 WHO broadly defines priority populations for PrEP as groups with an HIV incidence of about 3 per 100 person-years or higher.10 In high-prevalence, generalised settings this may include young people, adolescents and women.
The United Nations General Assembly’s 2016 Political Declaration on HIV and AIDS includes a commitment to providing three million people at higher risk of HIV infection with PrEP by 2020. However, by the end of 2017 only 350,000 people have ever taken PrEP, while the number of people currently PrEP is likely to be lower as many people only take PrEP for a short period. Around two thirds of PrEP users live in the United States of America (USA), , although access is expanding in a number of other countries and a significant number of people are also thought to be accessing PrEP through the internet.11
There is a serious discrepancy between who would benefit most from PrEP and who is currently accessing. There are many challenges associated with PrEP implementation and scale-up, as well as issues relating to individual adherence.
As of 2019, Truvada, a single pill that is a combination of ARVs tenofovir and emtricitabine, is approved for use as PrEP. Solo tenofovir has been tested as PrEP in two major studies: Partners PrEP, involving serodiscordant heterosexual couples (where one person is HIV positive and one is HIV negative), and the Bangkok Tenofovir Study involving people who inject drugs.12 Other ARVs such as Maraviroc are also being studied as possible PrEP alternatives.13
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%.15These statistics include individuals with lower adherence levels so the actual level of protection for those fully adhering is higher and near 100%.
For people facing limited options to protect themselves against HIV or for those who can’t or don’t want to use a condom, PrEP allows them to discreetly take control of their HIV risk.16
A number of high-profile trials have shown how PrEP can be an effective HIV prevention option in a number of different settings.