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Why and when to use PrEP

Written by Allison Cooper

The antiretroviral medication (ARV) oral pre-exposure prophylaxis (PrEP) has been welcomed across the world as one of the major HIV prevention interventions in the fight against AIDS.

It was rolled out to select clinics in South Africa by the National Department of Health in 2016, to help prevent high-risk HIV-negative people from contracting the disease. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent.

According to Pholosong Hospital’s medical manager Dr Nthabiseng Makgana, PrEP provides an additional prevention option for those working in a high-risk environment, like sex workers, or those with a partner who is HIV-positive.

PrEP is a tablet that must be taken daily if it’s going to significantly reduce a person’s chance of getting HIV. 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, these medicines can stop the virus from establishing a permanent infection.

“Patients need to be HIV-negative to qualify for PrEP and it must be demonstrated that they are at an increased risk of contracting the virus. The benefits of taking PrEP must outweigh the risk associated with the side effects of the drug. A potential candidate for PrEP also first has to undergo baseline tests, conducted by a medical clinician, prior to commencing treatment,” said Dr Makgana.

“Some clinics are already offering PrEP to high-risk individuals. They can consult their local clinic to find out about their PrEP programme,” she added.

Why PrEP is being used

“There was an increase in new HIV infection rates in women aged between 18 and 25, an increase in new infection rates amongst sex workers, and the dilemma of partners wanting to bear children when one is HIV-positive,” Dr Makgana said.

PrEP is also used to prevent HIV transmission from mother to child, prevent early neonatal deaths and the death of children under five-years-old. “It has shown a drastic decline in intrapartum and post-partum transmission to babies. But there are no reliable studies in South Africa about PrEP’s use by adults,” she added.

Common side effects

There are common side effects of taking ARVs, especially in the first month of therapy. Dr Makgana said these include fatigue, headaches and abdominal complaints.

“It is very important to be evaluated by a practitioner before starting treatment. When there is demonstrable evidence of increased HIV risk, the benefits outweigh the risk,” she said. 

For more information about PrEP, contact your closest primary healthcare clinic, HIV centre or the national AIDS helpline at 0800 012 322.