Access for all: Why women need PEP and PrEP now

by Laura Mundy

Image source: femalereport.wordpress.com

Around the world, 21.9 million people who are living with HIV aren’t on treatment. That’s 59%, which makes treating the virus a phenomenal task.

Recently, Martin Shkreli of Turing Pharmaceuticals jacked up the price of one drug commonly given to people living with HIV, Daraprim, from $13.50 to $750 per pill. Although this isn’t a drug that fights the HIV virus itself (it is actually an anti-parasite medication) it threw the issue of HIV drug access into the media spotlight.

TREATMENT AS PREVENTION 

Despite such low access to antiretrovirals, the reality is that this form of treatment is very effective at keeping people with HIV in better health. Antiretrovirals also cut the likelihood of transmitting HIV to a partner by 96% when drugs are taken as prescribed.

This led to the decision by the World Health Organisation in September 2015 that all people living with HIV should be offered treatment immediately after diagnosis, instead of when their immune system started to weaken, as recommended previously.

‘Taking treatment is proven to prevent onward transmission; the science is clear. It means that if all people living with HIV had access to the right drugs and were taking them as prescribed, it’s thought there would be no new infections by 2030.’

That’s the new target set by the joint United Nations programme on HIV/AIDS, UNAIDS. However, many countries are struggling to meet these guidelines with so many more people now requiring treatment.

Another limitation of antiretrovirals is that the responsibility and power to control the intake – and thus the effectiveness of the treament – lies solely with those living with HIV. Now, there is also preventative medication for people who are not living with HIV to take control of their health and prevent infection.

PEP – TREATMENT AFTER EXPOSURE

Post-exposure prophylaxis (PEP) is a course of antiretroviral drugs taken after potential exposure to HIV. It works by preventing the infection from becoming established in the body, killing it off before it infects the immune system cells.

It must be taken within 72 hours of exposure and is a 28 day course of treatment. It isn’t without its side effects, but completing the course is vital to preventing drug-resistance.

PrEP – TREATMENT BEFORE EXPOSURE

Pre-exposure prophylaxis (PrEP) is a slightly different combination of antiretroviral drugs taken before potential exposure to HIV, again preventing the infection from establishing. It must be taken every day, and has less side effects than PEP.

HOW IS THIS RELEVANT TO WOMEN? 

Around the world, women are at just as greater risk of contracting HIV as men. With women at least twice as likely to contract HIV during sexual intercourse than men and with higher exposure to gender-based violence, sexual assault and sex work, many argue that the risk is even higher.

Now, PEP and PrEP have the potential to put the power back in women’s hands – a vital tool to enable women to protect themselves from HIV.

However, these drugs are more commonly targeted at gay men and men who have sex with other men. They are also not available or approved everywhere, in fact only a handful of countries have approved PrEP so far including the USA, France, South Africa, Kenya, Israel and Canada.

Although their benefits could be monumental, the concern over cost remains a deciding factor in accessibility.

‘The world is currently gearing up to ensure that every person living with HIV gets treatment in line with the new guidelines set in September 2015. And yet latest statistics put worldwide treatment access at just 41%; meaning there is still a long way to go.’

Securing the benefit of the pre and post exposure drugs is an additional hurdle that seems insurmountable; when 21.9 million people who are living with HIV aren’t on any treatment at all. Critics say PEP and PrEP will also increase high-risk sexual behaviour potentially leading to an increase in other sexually transmitted infections, although there has been no evidence of this in trials.

Let me make this clear. PEP and PrEP are not alternatives for condoms. They are a safety net that should be available to every woman who is powerless to use condoms in certain situations. Women who have been sexually assaulted should be offered PEP, just the same as emergency contraception. Women who sell sex have comparatively high numbers of sexual partners and are often not able to negotiate safe sex.

Image source: sciencefriday.com

How can a woman whose partner is HIV-positive be 100% certain they are adhering to their medication? And shouldn’t pregnant women have the right to protect their unborn child from contracting HIV?  Using a condom requires both people to cooperate, whereas women alone can choose to take antiretrovirals.

ACCESS FOR ALL

HIV is often associated with homosexual activity or injecting drug use, when in fact more women than ever are at risk. Ending HIV transmission by 2030 is the goal, but in the meantime making sure PEP and PrEP are readily available will enable individuals to protect themselves and drastically cut the likelihood of being infected.

Making safer sex choices is a two person decision. But for the many women who are powerless to use a condom with an HIV-positive man, they should have the choice to take PEP or PrEP, now that the science proves they work. For a woman to have to rely on a man to take his treatment removes any choice from her, and that is what needs addressing.

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