Dr Steven Hong
Is HIV still around?
Yes. The latest prevalence of HIV in Namibia is 13.8 percent. That means 1 in every 7 people in Namibia lives with human immunodeficiency Virus (HIV) knowingly or unknowingly. That is still very high. Even though the use of antiretrovirals (ARVs) has been highly successful in saving lives, HIV is still around.
Does HIV still kill?
Yes. Although we have ARVs that save peoples’ lives, if ARVs are not started early enough, or if a person does not take their ARVs well, or if they are infected with a virus, which is resistant to ARVs, the person can still die. Yes, HIV still kills.
Therefore, the message has not changed after all this time. We need to avoid being infected with HIV.
What would you say if I were to tell you that there is a way for you to protect yourself from getting HIV?
You would say, “I know, the ABC’s. Abstinence, Be faithful, and Condoms”. And I would say, yes, I would agree. However, has it worked? Somewhat but not fully. Many people are still being infected with HIV every day in Namibia.
So what can we do? PrEP, Pre-exposure prophylaxis.
PrEP? What’s that?
Oh! You mean after I have unprotected sex, I have to take ARVs for a month. But those ARVs make people feel sick! NO, that’s PEP (post-exposure prophylaxis). PEP prevents HIV by using ARVs AFTER you’ve been exposed to HIV. That’s not what I’m talking about. PrEP is pre-exposure prophylaxis. You take one pill once a day BEFORE you’re exposed to HIV and you’re protected from getting HIV.
BUT ARVs are for people who have HIV? Yes, but the ARVs, Tenofovir Disoproxil Fumarate and Emtricitabine (TDF/FTC) can also be used to prevent HIV in people who are NOT infected. This is called PrEP.
BUT I heard that PrEP does not work well to prevent HIV. Well, actually the studies show that if the PrEP pill is taken every day, it is over 90 percent effective at preventing HIV. PrEP has been shown to work in both men and women.
BUT I don’t want to take the pills every day for the rest of my life! Well, you don’t have to take PrEP for the rest of your life like ARVs. PrEP is really meant to be used for the time in your life when you are at high risk of HIV exposure. When you are not at risk anymore, you can stop taking PrEP. If you decide PrEP is no longer needed, discuss stopping with a health care provider. You will get information about how long you should continue taking PrEP to make sure you are properly protected.
BUT the side effects will be so bad. How can I take that pill every day? Well, actually the studies show that PrEP has very little side effects and is well tolerated. Less than 10 percent of PrEP users may experience some “start up” symptoms in the first month, but they will go away. “Start up” symptoms? Yes, your stomach may feel a bit upset, but then those symptoms will soon go away. Additionally, PrEP is safe, with no major side effects.
BUT won’t PrEP cause people to have “riskier sex” because they know they are protected? Well, actually studies have shown that people on PrEP do not necessarily have “riskier sex”.
BUT won’t PrEP lead to more drug resistance? Well, studies have also shown very little development of drug resistance due to PrEP. In the small amount of people who have developed resistance, it was because they were already infected with HIV when they started PrEP. That is why it is so important to make sure you are tested for HIV BEFORE you start taking PrEP. Your health provider will also make sure that you are tested for HIV every time you go to pick up your PrEP pills.
BUT I drink alcohol sometimes. I have heard you cannot drink alcohol with ARVs. Well, actually PrEP (TDF/FTC) is not known to interact with alcohol in harmful ways. Continuing to take PrEP daily will still be protective.
BUT PrEP must be expensive; and I don’t have the money to buy it. Well, actually, PrEP is part of the Namibian Antiretroviral Therapy Guidelines and is provided free in public health facilities around the country for those at substantial risk for HIV infection.
Ah, okay I get it! PrEP taken by HIV-negative people, if taken every day, can protect people from being infected with HIV. This is great! I do not need to use condoms! Well, you still need to use condoms because PrEP does not protect you from other sexually transmitted infections such as syphilis or gonorrhoea. PrEP also does not protect you from unwanted pregnancy. In fact, PrEP is an extra HIV prevention option. It is not a stand-alone intervention to prevent HIV, it is part of a combination prevention package which includes condoms, PEP, voluntary medical male circumcision, counselling for safe sex, treatment for other sexually transmitted infections, and ART for people who have HIV already.
So, why NOT PrEP? PrEP works, PrEP is safe, people can adhere to taking PrEP every day, PrEP does not lead to more drug resistance, PrEP can be taken with alcohol, PrEP doesn’t lead necessarily to more high-risk behaviour, and best of all – PrEP is FREE at public health facilities!
No more BUT’s, let’s get PrEPed!
If you think you’re at substantial risk of HIV infection, talk to your healthcare provider or doctor.
* Dr. Steven Y. Hong is Deputy Chief of Party at The Society for Family Health in Namibia.
He is a medical doctor from the United States who specializes in Infectious Diseases and holds a Masters of Public Health.
The Society for Family Health is one of the first Namibian organisations that assisted the Government of the Republic of Namibia with implementation of PrEP in the Public Health Sector focusing primarily at those most at-risk of HIV acquisition.