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.

Wednesday, October 27, 2010

Are Healthy People More Likely to Take Drugs than Unhealthy People?

Loss to follow up is a common problem with HIV treatment programs and up to 40% of East Africans may cease to collect their drugs at some time. They may have gone somewhere else or died, but it's hard to tell. Records are not always well kept.

It's hard to know how good people will be at taking drugs to prevent HIV, as opposed to those that treat HIV. Early papers on adherence seemed keen to report good news, that people in developing countries were even likely to be better at keeping to treatment regimes than people in rich countries. But later papers have not always been so optimistic.

I have seen several mentions recently of people preferring to pray and believe that God will save them, keep them alive, 'cure' them of HIV, etc. People who believe this don't always stop their treatment, although some do. But even temporary lapses in taking antiretroviral drugs can cause problems such as opportunistic illnesses and resistance build up.

I have even come across people who have insisted that praying is the best response because God will decide, whatever the outcome is. This is disturbing to witness, especially when one suspects that many people taking this view also seem to associate HIV with some kind of evil or sin.

A recent article suggests that some young people in Uganda are being persuaded to give up taking Aids drugs and relying on their beliefs instead. Some of those persuading them are possibly not even genuine pastors, though it seems equally inexcusible whether they are genuine or not.

Proponents of PrEP tend to ignore the potential problems of ensuring that people who are not sick take drugs as required in order to prevent infection with HIV. Especially as research into exactly how most HIV is transmitted in high prevalence countries is thin on the ground.


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