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How to prevent HIV infection
PrEP is a drug that also reduces the risk of HIV/ Aids transmission after an accidental exposure. PHOTO/FILE
What you need to know:
- Following the latest statistics on HIV/Aids prevalence across the country, our reporter Tonny Abet presents how the PrEP HIV prevention drug works and other information you need to know about HIV.
Pre-exposure prophylaxis or PrEP refers to the use of antiretroviral medication by HIV-negative people to reduce the risk of contracting the virus.
PrEP works by preventing the human immuno virus, which can cause Aids, from establishing itself in the body. The drug acts as a catalyst that helps the body produce antibodies against disease-causing germs and viruses. When they come into contact with the virus, the antiretroviral components of PrEP, tenofovir and emtricitabine, block the enzyme needed by the virus to establish itself and multiply, according to medical literature.
In Uganda, the government has approved three PrEP options: oral tablets; a vaginal ring; and a long-acting injectable, cabotegravir (CAB-LA).
The Uganda Aids Commission, which coordinates the country’s response to the epidemic, recommends that PrEP be used in combination with other prevention methods like condoms.
The World Health Organisation in 2015 recommended tenofovir disoproxil fumarate (TDF)-based oral PrEP as an additional prevention choice. According to the global health agency, “oral PrEP is highly effective at preventing HIV when used as directed.”
Six years later, in 2021, the agency added the dapivirine vaginal ring as an additional prevention choice for women at substantial risk of HIV. A year later, CAB-LA was added to the menu as “an additional prevention choice for people at substantial risk of HIV”.
Currently, other multipurpose prevention products that combine antiretroviral drugs with contraception are also being studied in the race to end HIV/Aids as a public health threat by 2030.
The Uganda Aids Commission attributes the decline in annual new HIV infections from 53,000 to 38,000 between 2019 and 2023 to more people using prevention tools and treatment.
Dr Herbert Kadama, the Health Ministry’s PrEP coordinator, says there has been an increase in the number of people using the preventive methods. But he notes that the uptake is not at the desired level despite the drugs being given free.
“As a country, we started with oral tablets in 2017. We started with 800 people on tablets but as I talk now the people are over 700,000. It is taken orally, once daily,” he says.
“The uptake has not been that great; there are continuity issues because people have problems with pill burden and stigma, they are asked by their partners, ‘what are these pills, why are you taking these pills?’
“We are seeing cases of gender-based violence and issues of access, people do not have transport [to health facilities], and many are not coming back for treatment,” he adds.
According to information from America’s Centres for Disease Control and Prevention, “Oral PrEP is up to 99 percent effective at preventing HIV acquisition from sex and at least 74 percent effective at preventing HIV acquisition from injection drug use.”
Dr Vincent Bagambe, the acting director general of UAC, says the government has ensured increased access to PrEP.
“Currently, drugs are available and they can be accessed in almost all health facilities in Uganda. If you approach a health worker, they will ask you questions and establish if you are at risk, they will give you PrEP,” he says.
“The categories of people that have been prioritised are people in discordant relationships, but also female sex workers, including adolescent girls and young women,” he adds.
Discordant relationships are those in which one in a pair of long-term sexual partners is HIV-positive while the other remains HIV-negative.
Dr Kadama says plans are underway to provide the oral pills in private pharmacies where those in need can access them for free. The vaginal ring, which is inserted into the female sexual organ is available in seven health facilities in Mbarara, Malaba, Kitgum and Gulu and are free. The official reveals that with support from the Global Fund, a basket funding mechanism that supports work against tuberculosis, malaria and HIV/Aids, the rings will soon be available at four new facilities in Masaka, Kampala, Jinja and Kyenjojo.
Protection from the vaginal ring kicks in one day after it is inserted. “Before that you have to use a protective method,” Dr Kadama says.
“The ring stays for 28 days after the 28 days you remove it because the medicine is over, and you need to replace it with a new one.”
Dr Kadama notes with concern reports that some women are sharing the ring.
“The ring is not for sharing,” he warns.
The coordinator, however, noted that only 630 people have used the ring because only a limited number were imported.
“This is something new in the country and we are learning,” he says.
Dr Kadama noted that although some people report side effects while using these tools, these disappear within a short time. For the vaginal ring, he says a few women report cases of urinary tract infections, which are treatable.
The injectable PrEP, CAB-LA, is currently under use in clinical research studies but the Ministry of Health has plans to import 10,000 doses.
Dr Kadama says the CAB-LA injection is administered every two months to prevent contracting HIV from any form of exposure. It starts preventing HIV seven days after the injection.
A health worker tests a patient for HIV/Aids. PHOTO/FILE
Injection
He further explains that after the drug is injected into the buttock, it is slowly released from the muscle into the body and enters the bloodstream, building up in the cells of the body.
“When it is in the bloodstream, it will build up with the cells, and it manages to prevent HIV infection. So, this one is given, you come, you are assessed, HIV negative, are you at risk? If you are eligible, you are initiated, you will be getting your injection every two months as long as you are at risk,” Dr Kadama says.
Dr Bagambe says a new drug, Lenacapavir, which is given once every six months, is under trial and will be introduced if the results are positive. Recent data show that the drug had 100 percent effectiveness in preventing infection.
Dr Kabagambe also says there is post-exposure prophylaxis, the treatment given after one has been exposed to the virus to prevent infection.
About HIV/AIDs prevention
How to protect yourself from HIV
.Abstaining from sex.
.Being faithful to your sexual partner.
.Using condom.
.Taking Pre-Exposure Prophylaxis (PrEP) before risky sexual activity.
.Taking Post-Exposure Prophylaxis (PEP) after risky sexual activity.
. Get tested for HIV.
How HIV prevention drugs work
.PrEP works by preventing HIV from establishing itself and multiplying in the body.
.PrEP prompts the body to boost production of antibodies that fight infections.
HIV figures
.1.49 million people living with HIV/Aids by 2023.
.20,000 Aids-related deaths in 2023.
.38,000 new HIV infections in 2023.
.HIV prevalence is 5.1 percent.
New HIV prevention tools
.Oral pills taken once daily (700,000 people using for free).
.Injectable drug given once every two months (Free 10,000 doses expected).
.Vaginal ring which has antiretroviral drug (630 people use it for free).
Some of the PrEP side effects
1. Diarrhoea
2. Headache
3. Nausea
4. Rash
5. Dizziness
6. Fatigue
7. Stomach pain
8. Weight loss
9. Decreased appetite
10. Bloating
11. Insomnia
