Pre-Exposure Prophylaxis or PrEP

Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. This blog looks at some of the pros and cons of PrEP.

Thursday, September 30, 2010

Do Family Health International Care About Women or Funding?

A quick look at the HIV/AIDS and Malaria Indicator Survey for Tanzania (or any other African country) will show that 'HIV' always means 'sexually transmitted HIV'. The so called 'ABC' strategy (Abstain from sex, Be faithful to one sexual partner, use a Condom) is still about as far as the global HIV industry has got in terms of HIV prevention. Over 50%, often over 80% of people between the ages of 15 and 49 know about at least one of these methods of reducing the risk of sexually transmitted HIV.

It would be more comforting if a higher percentage of people knew about all the ways of preventing HIV, but that would need to include non-sexual transmission, as well. People answering questions about ABC are prompted but it takes a lot more prompting to get people to suggest non-sexual modes of HIV transmission. Such modes are deemed not to be important enough to include in the Survey. Some people know about them, rather surprisingly, but how many know how to avoid or prevent non-sexual HIV transmission?

PrEP and a handful of other interventions are also aimed at sexual transmission of HIV. While some drugs may also reduce non-sexual transmission, this is not their aim. And telling people they could take antiretroviral drugs to avoid being infected with HIV when they pay a visit to a health facility, a dentist's surgery or the hairdresser might not be the best way of selling the technology.

So gushing about vaginal microbicides "giving women a new tool to protect themselves from HIV infection" sounds like humbug when it comes from FHI's Ward Cates. If FHI gave a damn about women being able to protect themselves from HIV, why do they not take so much interest in non-sexual transmission? After all, they have received hundreds of millions of dollars to try to influence women's behavior, in relation to sex, reproduction and health in general. If they are not in a position to warn about non-sexual transmission, who is?

Of course, there is a set of questions about medical injections and about whether the equipment used was taken out of a sealed packet. But these matters do not usually make up part of HIV prevention programs and few programs mention either the risks from medical injections or the steps people can take to reduce the risks of infection with HIV or any other blood-borne viruses. None of the Aids Indicator Survey questions aim to establish how HIV positive people might have become infected.

The company that produces the drug used in the microbicide gel, Gilead, is one of the many multinational drug companies that sponsors FHI. It wouldn't do Gilead, or anyone else betting on sexual transmission of HIV, any good if non-sexual transmission were to play a significant role in the epidemic in African countries. But luckily, there's a whole pack of companies and even funders who have similar interests, which don't include nosocomial or iatrogenic HIV transmission. Who are they? Just take a look at FHI's list of funders.


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