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.

Friday, January 21, 2011

Crumbling, Staffless African Health Systems Bombarded With Drugs

With all the hubris about drugs and new medical technologies, you'd think that hospitals in East African countries are ready to save their whole populations if they could just get hold of the latest drugs. This is far from the truth.

Drugs that arrive in the country often don't get distributed and expire before they are used, they get distributed to the wrong people and disappear into the black economy, they are prescribed by people who don't know how to prescribe them properly, they are already useless because of widespread resistance, etc.

Even antiretroviral drugs have a bit of a mysterious time once they reach here. Some people are kept alive by them but the majority of people who need them don't yet get them. Another mystery is how many people die while on the treatment, or why treatment sometimes fails where it would have been predicted to succeed. And a huge number of infants are still infected by their mothers, despite promises that this phenomenon will soon be phased out.

Despite all the money being thrown at HIV, and very little else, health services just can't cope. There isn't the infrastructure or the level of skill required to ensure the health of most people and many, even those with HIV, are dying of easy to treat illnesses.

It's good to see an admission that the problem is at least partly with health systems but it would be even more comforting to hear that big funders are doing more to improve health systems than just talking about it. Strategies like PrEP, treatment as prevention, mocrobicides, etc, will be of little use if they don't get to people or if they are not used optimally when they do.

Which reminds me, why do countries that are so short of infrastructure, medical supplies and especially personnel think that mass male circumcision is so important when their health services are in crisis and have been for some time?

Apparently Tanzania has circumcised a few thousand men but so have Uganda and other countries. And Kenya claims to have circumcised 250,000 in a very short space of time. I'm glad I'm not one of the, having seen the state of some health facilities in East Africa.


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