In Kenya 1.5 million people are living
with HIV, and there are about 100,000
new infections every year. Despite this,
some sex workers are having
unprotected sex – and taking
antiretroviral drugs afterwards to cut
the infection risk. How reckless is this?
"Let me tell you the truth about why
many of us don't use condoms," says
Sheila who has been a prostitute in
Nairobi's Korogocho slum for six years.
"We don't have money, and when you
meet a client who offers to give you
more money than you usually get, you
have sex without protection even when
you don't know his HIV status."
Sheila says she and other prostitutes
can go to a clinic the next morning to
get emergency antiretrovirals – drugs
which suppress the virus, if taken
within 72 hours of infection, and in
many cases stop its progression.
"We use this medicine like condoms,"
she says.
The type of antiretroviral in question is
known as post-exposure prophylaxis, or
PEP.
It is intended to be used in
emergencies. For example, it is given to
victims of rape if their attacker is
thought to be HIV-positive, or to medics
who have been pricked by a potentially
infected needle.
There are no definitive figures to show
how well PEP works. It's far better,
experts say, to prevent exposure the
virus in the first place, by using
condoms.
Some clinics will only give clients one
course of PEP a year. They worry that if
they hand the drugs out too freely,
prostitutes will stop using condoms
altogether.
This hasn't stopped 24-year-old sex
worker Pamela using PEP four times in
the past year.
"I had unprotected sex when I was very
drunk one night and the following
morning I didn't go to the same clinic
where I got the first PEP tablets… I went
to a different clinic where they don't
have my records, and lied that I was
forced into unprotected sex," she says.
She didn't finish the full course because
of the side-effects. "You feel bad, like
vomiting, dizziness, and generally you
just feel sick," she says. "So I stopped
taking them."
Peter Godfrey-Faussett, senior science
adviser with UNAIDS, says there is a
place for antiretrovirals among sex
workers, but only when used in the
right way.
"We know that despite fairly high rates
of condom use in many sex-work
communities, we still have very high
rates of HIV so we need additional tools
as well as what's already happening,"
he says.
However, emergency use of PEP is not
the best way to go about it, he says.
Instead it would be better for
prostitutes to take a type of
antiretroviral designed to be taken
before exposure to HIV – known as Pre-
exposure prophylaxis (PrEP).
These are taken daily, and contain
fewer drugs than PEP, so there are
fewer side effects. But Godfrey-Faussett
stresses that they must be used as part
of a wider package, including regular
HIV testing to make sure that the
patient is on the correct medication.
There are plans to run a pilot
programme with sex workers in Kenya
to see if it could be practical for them to
use PrEP as an extra layer of defence.
The drugs are not cheap, though.
In the US, PrEP costs around $14,000
(£8,700) a year at the full price,
although people on low incomes can get
it much cheaper, or even free.
In developing countries, where generic
copies of the drugs are used, the cost
may be about $150 (£93) a year.
Godfrey-Faussett stresses that the
cheapest line of defence is, in this case,
the strongest.
"Condoms are the single most effective
way of preventing HIV, sexually
transmitted infections and pregnancy,"
he says. "PrEP is not a silver bullet that
will suddenly take away all those other
issues."
source: BBC
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