PREVENTION

HIV: Light at the end of the tunnel

In Summary
  • New HIV infections among young women aged 15–24 were more than double those among young men.
  • One cannot always carry condoms or take PrEP seven days before exposure to HIV, or even take the PrEP pill daily when not sick.

As the world marks the world Aids Day today, we are not short on successes to celebrate despite Covid-19 threatening to compromise the gains made so far in HIV response. Being the fourth decade in the HIV response since the first case was diagnosed in Kenya (1984), we can boast of 69 per cent of adults above 15 years living with HIV enrolled on life-saving HIV treatment.

However, according to UNAIDS as of 2018, 1.6 million Kenyans were living with HIV, 65 per cent of whom were women. Currently, about 275 young girls are getting infected with HIV weekly. New HIV infections among young women aged 15–24 were more than double those among young men.

Women and girls are disproportionately affected by HIV due to various vulnerabilities among them sexual and gender-based violence, gendered stereotypes, poverty, complex female anatomy, multiple sexual partners, and lack of and inaccessibility of HIV prevention options.

Ending the Aids epidemic as per the global targets requires revamped focus and investment in innovative structural, behavioural and biomedical HIV prevention interventions. Existing biomedical interventions such as male and female condoms, voluntary medical male circumcision, oral pre-exposure prophylaxis and post-exposure prophylaxis exhibit low uptake among adolescent girls and young women despite their effectiveness.

 

These products and interventions have not done enough in preventing the spread of HIV as they are not entirely desirable due to the methods of use, diversity of women, side effects and barriers to access.

A look at the HIV prevention research pipeline shows a goldmine with several appealing biomedical products on trials that will cater to our needs in all our diversity should they be successful and get approved by the regulatory agencies. Topping the list of those in the advanced stages of research are CAB LA, the dapivirine ring and the multi-prevention technologies.

Existing biomedical interventions such as male and female condoms, voluntary medical male circumcision, oral pre-exposure prophylaxis and post-exposure prophylaxis exhibit low uptake among adolescent girls and young women despite their effectiveness.

The dapivirine vaginal ring developed by the International Partnerships for Microbicides got a positive scientific opinion from European Medicines Agency on July 24, 2020. It is the first long-acting HIV prevention product. It is an intravaginal silicone ring that can be inserted in the vagina for monthly protection against HIV as it delivers the antiretroviral drug dapivirine.

The long-acting cabotegravir (CAB LA) is an injectable PrEP under investigation that involves receiving an injection every two months. Trials were stopped early by the Data and Safety Monitoring Board as results showed CAB LA to be highly effective in preventing HIV acquisition as compared to oral PrEP

MPTs are integrated products that deliver varied combinations of HIV, STI prevention and contraceptives. Male and female condoms are the only available MPTs currently. There are at least 22 MPTs in the research pipeline, including the 90-day multipurpose vaginal ring and the dual prevention pill.

For young people sex is a spontaneous action and not a premeditated one; one cannot always carry condoms or take PrEP seven days before exposure to HIV, or even take the PrEP pill daily when not sick.

One needs to be constantly protected hence the potential that these products will be largely accepted and utilised by women and girls.

 

The research pipeline provides opportunities for product integration and new product introduction. It is critical to note that the products in the research pipeline will not replace the existing one but complement efforts to reduce HIV infection rates across different populations through combination prevention as no single entity or intervention can eliminate HIV alone.

There is urgent need to polish our policies and guidelines to include and prepare the country for new products that will provide more HIV prevention options for women and girls and lead us to the desired zero new HIV infections.

Aids Vaccine Advocacy Coalition 2020 fellow