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Lifesaver: the PrEP injectable is a game-changer in the battle against HIV/Aids


Jillian Green is a Daily Maverick managing editor.

The announcement of the results of a study of an injectable antiretroviral that can turn the tide on HIV infection - particularly in women, who continue to bear the burden of infection - shows how far we have come in the protracted battle.

First published in DM168

More than 14 years ago, in a previous iteration of my career in the media, I was the Aids Writer for The Star newspaper.

Then it was not uncommon for there to be several stories around HIV/Aids in the various daily editions of the newspaper that existed at the time. Stories of how political leaders (read former president Thabo Mbeki and his then health minister, Manto Tshabalala-Msimang) were mangling the country’s response to the HIV epidemic by failing to acknowledge that HIV causes Aids and, among other things, peddling beetroot, garlic, African potato and vitamins as viable treatment options.

There were stories of how the Treatment Action Campaign had to take government to court to force it to provide the lifesaving antiretroviral, nevirapine, to pregnant women to prevent mother-to-child-transmission of HIV.

And there were stories of the awful stigma that those living with the virus had to endure from loved ones and strangers alike. But there were also stories of hope, particularly around scientific discoveries and developments.

And there were South African researchers and scientists leading these developments despite the quackery of Tshabalala-Msimang and the denialism of Mbeki.

All these stories came flooding back this week with the announcement of the results of a study into an injectable antiretroviral that, when administered every two months and used as a pre-exposure prophylactic (PrEP), will prevent HIV infection.

Oh, how far we have come!

In 2006, I reported in The Star that “Researchers from the United States’ Centres for Disease Control and the National Institutes of Health hypothesise that giving an uninfected individual a daily pre-exposure of antiretrovirals (ARVs) may prevent that individual from infection by disabling or interfering with the HI virus within a period after an individual is exposed to the virus.”

Clinical trials were about to be undertaken and scientists like SA’s own Helen Rees were cautiously optimistic that while PrEP would not be a “magic bullet” it could be “another weapon in our armoury against HIV infection”.

It was heady stuff at the time.

Fourteen years later, not only were the clinical trials successful, PrEP pills taken daily by people at high risk of HIV infection are now a key part of the arsenal in the fight against HIV.

Now it’s available as an injectable, which the recent study has found to be more effective than the current daily PrEP pill. According to Rees, the executive director of the Wits Reproductive Health and HIV Institute (WRHI), this  is a “game-changer” to turn “the tide on HIV” infection, particularly in women, who continue to bear the burden of infection.

According to UNAids, every week, about 5,500 young women aged 15 to 24 become infected with HIV, and of the 1.7 million new infections in 2019, women and girls accounted for almost half (48%) of those. Unequal cultural practices, economic dependence and social status coupled with intimate partner violence and the unequal power dynamics between men and women place women and adolescent girls at increased risk of infection. This development starts to return power over our bodies to our hands – where it belongs.

For too long vulnerable women have had to negotiate safe sex with partners who seemingly care little for their health. Instead of trying to explain why you are taking an ARV even though you are HIV negative to a sexual partner who does not want to wear a condom, or who may be unfaithful, a woman will in the near future be able to visit a clinic every two months to have the PrEP injection. Just like birth control. This is indeed a game-changer, a lifesaver.

Rees captured it perfectly: “These results are a milestone for prevention of HIV among women at risk of HIV worldwide and especially for women in sub-Saharan Africa. If we are to turn the tide on the HIV epidemic, we will need prevention options that work for women in sub-Saharan Africa. These findings provide great hope and motivation for additional studies to show safety and acceptability in adolescents, pregnant and breastfeeding women.”

It’s indeed heady stuff again that can’t be celebrated enough. DM168

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