PrEP Technologies Tried in Africa as HIV Prevention Method

African Institute looks at a study of PrEPs technologies in Africa. It is a new technology that provides to couples of mixed HIV status where one partner is living with HIV and the other has no HIV but both partners want to have sex without using condoms for protection. We encourage our readers to read these new studies and technologies being introduced and realise that no perfect single intervention should be taken in isolation. We believe that condoms offer better protection with no side effects. If the PrEP becomes a popular way of prevention in the developed world that will only add into the HIV treatment bill and the probabilities are that no many countries will afford to offer those to the entire population that needs PrEP and manage to also pay for other treatments due to side effects caused by PrEP. 'We, therefore, think that both male and female condoms provide great prevention against HIV virus and fight the stigma attached to the virus.' said Mr Amdani Juma, the AISD Director                     Photo Gordon Brown in Kenya 

Kenyan heterosexual couples want a choice of antiretroviral prevention methods

Michael Carter   

Published:  May 2012

Approximately 40% of HIV-positive people in stable relationship with an HIV-negative person in Kenya have reservations about starting antiretroviral therapy early for the purposes of prevention, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Willingness to use pre-exposure prophylaxis (PrEP) was high among the HIV-negative partners. However, this finding is likely to have been influenced by the fact that the study involved couples involved in a PrEP study.

The investigators believe that their findings could have implications for the use of HIV treatment in prevention.

A possible HIV-1 prevention strategy for serodiscordant couples that will utilize both ART [antiretroviral therapy] and PrEP is for the HIV-1-uninfected partner to use PrEP until the HIV-1 infected partner is willing and able to initiate ART,suggest the authors. Such a strategy would be cost-effective, provide HIV-1 infected partners an opportunity to decide when to start ART, and may allow a bridge period for a few months after the infected partner starts ART, when transmission may still be high because viral load is not yet suppressed.

Antiretroviral-based strategies are among the most promising new approaches to HIV prevention.

Research involving serodiscordant heterosexual couples showed that early antiretroviral therapy reduced the risk of transmission of the virus by 96%.

Some research has also shown that antiretroviral drugs taken by HIV-negative people (PrEP) can reduce their risk of transmission.

Serodiscordant couples are a priority population for the use of HIV treatment. But, before strategies for its use are developed, it is important to understand the couples preferences for and concerns about the use of antiretrovirals for this purpose.

Investigators therefore recruited 181 serodiscordant couples in Kenya, enrolled in the Partners PrEP study, to a substudy enquiring about their willingness to use HIV treatment as prevention.

The HIV-positive partners all had a CD4 cell count above 350 cells/mm³ and were therefore ineligible for antiretroviral therapy according to Kenyan national guidelines. The study was conducted between March and July 2011, before the publication of research showing the efficacy of PrEP in heterosexual couples and of the results from the HTPN 052 study, which showed that early HIV therapy reduced HIV risk by 96% in serodiscordant heterosexual couples.

Both the HIV-negative and HIV-positive partners completed questionnaires.

HIV-negative individuals were asked: If we find that PrEP works to keep people free from HIV, would you be willing to take PrEP tablets every day for the next five years?

HIV-infected partners were asked: Would you be willing to start antiretrovirals before your CD4 count reaches 350 if it would lower your chances of giving HIV to your partner?

Participants were asked to describe their main concerns about early HIV treatment or PrEP. They were also asked to say which of these strategies they preferred.

Some 69% of HIV-positive men and 58% of HIV-positive woman said that they would be willing to take early treatment for the purposes of prevention.

An overwhelming majority of HIV-negative people (94% of men and 86% of women) expressed a willingness to take PrEP.

When asked to state a preference between the two approaches, 61% of HIV-positive men and 50% of HIV-negative women said they would prefer early HIV therapy.

A majority of HIV-negative participants expressed a preference for PrEP (57% of men and 56% of women).

In just over a quarter of couples (26%), both members preferred to have the HIV-negative partner take PrEP and in 22% of couples both members preferred early antiretroviral therapy for the infected partner.

Among HIV-positive participants, the primary concerns about early treatment for prevention were side-effects (51%), stigma (21%), pill burden (19%) and fears about resistance (18%).

A total of 14 HIV-negative people were unwilling to use PrEP. Their primary concerns were the duration of treatment (6/14), taking treatment when they were not sick (3/14), and side-effects (3/14).

In our study, not all couples would be willing to use ART prior to the HIV-1 infected partner having clinical symptoms and a perceived need for initiation; PrEP could be a suitable alterative for these couples,conclude the authors. As antiretroviral-based HIV-1 prevention strategies are incorporated into prevention policies and programs, it will be important to understand and accommodate couples 'preferences and willingness to use antiretroviral-based HIV-1 prevention.'

Reference: Heffron R et al. Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral based HIV-1 prevention strategies. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e31825da73f, 2012.

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NATIONAL CONDOM WEEK AND PREVENTION TECHNOLOGIES

THE FEMALE CONDOM

The African Institute has launched the National Condom Week in Nottingham on Monday 21st May and will run till 28th May. 2000 condoms were packed and mass distribution is underway from street, community businesses and live Radio media interview for condoms and lubs collection.

There is an urgent need to expand access to proven prevention methods, including clean needles, female and male condoms, risk reduction counselling, treatment of sexually 

transmitted infections, and other strategies. 

                                                                                              

  Below photo of Cllr Leon Unczur Sheriff of Nottigham then and current Lord Mayor
This year the AISD has made a focus on FEMALE CONDOM or FEMIDOM. "We want women to be in charge of their sexual health and share control, and pleasure with their male partners" said Amdani Juma, the Institute Director. He added that "each prevention technology present possibility of new option for individuals to help reduce their risk of HIV. no one of the interventions on their own can end the epidemic

The femidoms have improved greatly over years and we now have "Softer and more Sensual."

Imagine a tool that can be worn by a woman during sex, that protects against pregnancy, HIV, and other STIs. In case that isn’t enough, it also enhances pleasure for both her and her partner. It is inserted into the vagina before sex, and part of it stays outside of the woman’s body, where it increases the sensation of sex by rubbing against her labia and clitoris. 

It is strong, soft, and transparent, and is excellent at transferring heat. Her partner likes that it doesn’t constrict his penis, making sex feel more natural. And since it doesn’t rely on an erection, it can be inserted hours before sex, getting her in the mood and maintaining the flow of sex. What is this amazing thing? It’s a female condom!

The female condom has been on the market for 20 years and recently new innovations have emerged. The traditional female condom (FC2) – which has an inner and an outer ring – is made of synthetic latex, eliminating the noise that some people found distracting. There are also other female condoms available and under development, including a latex condom that has a firm sponge in the place of the inner ring, and another, Woman’s Condom, that can be inserted like a tampon, expanding during intercourse. 

demand for female condoms grows, we expect to see even more innovation in the market, because as we all know, variety is the spice of life!

Female condoms have several advantages. Women are in control when they use them. The use of male condoms often has to be negotiated over and over again and relies on the cooperation of men. Female condoms have to be negotiated only once. They can be inserted several hours before the sexual act takes place, so foreplay does not need to be interrupted.
Studies report a high satisfaction rate by both women and men who have used the female condom. Originally, the demand came mostly from women, but we see the number of male consumers increasing. In sum, the female condom is a commodity for safety, but also a pleasurable tool that should be accessible for all!

Prevention Technologies

Vaccines: An AIDS vaccine is an experimental strategy that aims to teach the body's immune system 

how to fight HIV to reduce the risk of infection or to reduce viral load in those who get the vaccine and 

go on to become infected. All of the candidate vaccines being studied are experimental; there are no 

effective AIDS vaccines available today. 

Pre-Exposure Prophylaxis (PrEP): PrEP is an experimental approach that uses antiretroviral 

medications (ARVs) to reduce the risk of HIV infection in HIV-negative people. During a study of gay 

men, transgender women and other men who have sex with men, a daily pill reduced the risk of HIV 

by 44%. Additional studies are ongoing in other populations. PrEP is not yet recommended for use. 

Note: PrEP must not be confused with post-exposure prophylaxis (PEP), which is available in the UK 

following exposure to HIV. 

Microbicides: The term microbicide refers to various strategies being tested that may reduce the risk 

of HIV transmission during sex. These include creams, gels, and suppositories that could be used 

vaginally or rectally. The large majority of microbicide candidates in testing today are formulated with 

antiretroviral (ARV) drugs. There is now proof of concept that a topical gel can reduce women’s risk of 

acquiring HIV during vaginal sex. However, more research is needed before such gels are available.

Male circumcision: Medical male circumcision (MMC) is the removal of all or part of the foreskin of 

the penis by a trained health professional. The term medical male circumcision differentiates 

circumcision that is performed by a trained health professional from traditional circumcision, which is 

performed as part of a religious ritual or cultural rite of passage. Adult medical male circumcision can 

reduce men’s acquisition of HIV by up to 65% when they have vaginal intercourse. However, there is 

no evidence that it also protects the female partners of men who are HIV positive and it remains 

unclear whether circumcision could have an impact on HIV transmission among gay men and other 

men who have sex with men. 

Treatment as prevention: Treatment as prevention is a term describing the use of antiretroviral 

drugs that are used to reduce the risk of passing HIV to others. The strategy would function as a 

secondary benefit of antiretroviral treatment after its primary purpose of improving an individual’s 

health. The rationale for this approach is that ARVs reduce viral load. Higher viral loads have been 

linked to increased risk of passing HIV to sexual partners. 

Treatment as prevention is an emerging area and there are different terms and phrases used to 

describe this approach, including "test and treat" and "testing and linkage to care plus" which 

recognizes that voluntary HIV testing and diagnosis is the first step to accessing care.

Sperm Washing: Sperm washing is a technique developed for couples who wish to conceive a child, 

where the male partner is living with HIV and the female partner is not. By isolating sperm from any 

elements in semen which may contain HIV, the risk of transmission of HIV to the female partner and 

subsequently her child is greatly reduced. A variety of assisted reproduction techniques can be used 

to fertilise the female partner with the washed sperm. Numerous observational studies have shown 

that sperm washing has not resulted in any seroconversions when correctly performed, and it is 

currently considered the safest method for serodiscordant couples wishing to conceive a child 

together. 

Sperm washing is available in the UK, however its availability is limited to two clinics and the dramatic 

variability of funding available throughout the country coupled with significant costs is a barrier for 

many couples. 

End of report.

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