How beneficial is PrEP and PEP?

By Peter Garang Ngor

PrEP, short for “ pre-exposure prophylaxis”, is an HIV prevention strategy in which HIV negative people take an oral pill once a day before coming into contact with HIV positive individual to reduce their risk of HIV infection. PrEP must be taken for at least 7 days to reach optimal levels of protection against HIV. In 2015, the World Health Organization (WHO) released new guidelines and a policy brief recommending that PrEP should be offered as a choice to people who are at substantial risk of HIV infection, for example those who have an HIV-positive partner, are unable to negotiate condom use, or are having repeated sex without a condom. Previously, it was only recommended for certain key affected populations such as sex workers, men who have sex with men and people who inject drugs.

PrEP is a daily course of ARVs that can protect HIV-negative people from HIV before potential exposure. Studies have shown that, when PrEP is adhered to exactly as prescribed, it reduces the chances of HIV infection to 90% in hetero-sexual partners or to nearly-zero. As a result, like treatment as prevention, PrEP potentially has population-wide benefits. However, if not taken consistently, PrEP is much less effective and the risk of HIV infection increases substantially. It also does not provide protection against other Sexually Transmitted Infections (STIs) and blood-borne illnesses such as hepatitis C, syphilis, and gonorrhea. For more effectiveness, PrEP needs to be combined with other preventive strategies like condom use.

PEP on the other hand, short for “post-exposure prophylaxis”, is short-term antiretroviral treatment taken after possible exposure to HIV. PEP is HIV prevention strategy in which HIV-negative individual takes anti-HIV medications after coming into contact with HIV infected individual or objects to reduce their risk of HIV infection. PEP must be started within 72 hours after HIV exposure.  Since 1998, it has been used by healthcare workers who may have been exposed to HIV-infected fluids. More recently, it has been used as an emergency prophylaxis for those who may have been exposed during a single event, for example sexual assault, unprotected sex or sharing drug injecting equipment.

More research is needed into the effectiveness of PEP as an HIV prevention strategy. One trial from the mid-1990s, which gave zidovudine to healthcare workers exposed to HIV, prevented transmission in 81% of cases. However, its use in PEP has since been replaced by tenofovir as a component of a three-drug combination.

PEP is most widely accessible in South Sudan especially in areas where ART centers are available and can be obtained by prescription from a medical provider such as a physician, nurse practitioner after possible exposure. This must be done within 3 days and taken for 28 days. Neither PEP nor PrEP protects an individual from other STIs or pregnancy.

As we have read that PrEP and PEP can be as good as other HIV prevention strategies in reducing the transmission of the virus, their wide availability across the country coupled with low level of awareness is still a great challenge. As a result people are lulled despite the HIV infection being alarming.

In order to make HIV and AIDS free South Sudan, the government needs to approve the usage of PrEP like other countries that have already done as well making such services available to population.  It is equally important to note that are more ways for someone to protect him/herself ever than before. If you are exposed or at risk of HIV infection, please do not hesitate to visit any nearest health facility

In my next episode (5), we shall be looking at Stigma and discrimination, its impact on HIV clients.

The writer is a clinical officer and a youth activist reachable via: +211954060175

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