Most people at the highest risk of HIV infections are not using freely available pills to prevent infection, a new study suggests.
Men who have sex with men (MSM) and transgender women have among the highest infection risks, but researchers said the majority of them are not using the prevention pills.
MSM are 18 times more likely to contract HIV compared to the general population.
The pre-exposure prophylaxis (PrEP), introduced in Kenya in 2017, prevents HIV almost completely even in condomless sex.
In the latest study at the coast, researchers followed 42 MSM and 11 transgender women for 12 months.
The 53 were all HIV negative and were expected to be on Prep throughout the period.
"At the month six appointment, participants on PrEP provided a blood sample for Tenofovir drug level assessment," researcher Makobu Kimani said.
Kimani led the study supported by the Durban-based Sub-Saharan African Network for TB/HIV Research Excellence (Santhe), a network of African researchers in HIV and TB.
Kimani says 81 per cent of the study participants said they regularly had anal sex, considered the riskiest.
Only 14 per cent consistently used condoms during sex, 74 per cent said they sometimes used it while 12 per cent never used condoms.
When the levels of the drug were tested in the blood, 75.6 per cent of the samples had undetectable levels.
This means although the participants continued picking pills at the clinic, they never consistently used them.
Only 24.4 per cent had detectable drug levels, mostly transgender women.
“Just because people show up for appointment does not mean they adhere. Adherence is very personal,” Kimani says.
“Many expressed interest in the long-acting PrEP but even with that, behaviour change will be required,” Kimani said.
The results have perplexed researchers because HIV has no cure yet those most at risk shunned free prevention pills.
They are now studying the group further to establish the reasons for this, but say it is not linked to any side-effects.
Elizabeth Wahome, who has also studied PrEP use among the MSM in Mtwapa, says: “HIV starts with behaviour and ends with behaviour."
She suggests people lack adherence because they are not conscious of their HIV acquisition risk. The discordant couples are more conscious of their risk, and have better adherence, she says.
“The society must also understand PrEP is not a sign of promiscuity.”
Clara Agutu, a Santhe scientist, says adherence to PrEP depends on how it fits into one’s daily schedule.
“In the beginning probably there was too much focus on serodiscordant couples, but PrEP is for all high-risk populations.
Although the study has not been published in a refereed journal, it aligns with other recent studies on the uptake of PrEP in Kenya.
