How would you feel if a nurse offered you a huge blue tablet and told you that you have to swallow it with water every day?
The HIV prevention pill Tenemine (a generic form of the brand name drug Truvada) is big and bulky. At almost 2 cm long and almost 1 cm wide, it is about the size of a large jelly bean.
The tablet is made up of two antiretroviral medicines used to treat HIV, called tenofovir and emtricitabine. If taken daily, the drug can reduce a person’s chance of contracting HIV through sex by up to 93%, studies show. The researchers also found that taking the drug one day before and two days after sex worked equally well in preventing infections in men who have sex with men and transgender women.
This type of protection is called pre-oral exposure prophylaxis, or PrEP, a medicine you take before you’re exposed to a potentially harmful germ.
But the high level of protection kicks in only if people keep taking the drug. The less often someone uses the drug, the lower the level of protection.
At The Aurum Institute, an HIV and TB nonprofit, we have been running a PrEP program at five of our Pop Inn Wellness Centers in KwaZulu-Natal, Gauteng and Mpumalanga. These facilities are specifically designed for men who have sex with men and transgender women, two groups that are more likely to become infected with HIV than the general population, in part because the likelihood of contracting HIV through anal sex can be up to 18 times greater. greater than that of vaginal sex.
The size of the tablet was one of the reasons people refused to take the drug. As of September 2019, only about 8% of people visiting Pop Inn clinics in Ehlanzeni, eThekwini, uMgungundlovu, Tshwane and Ekurhuleni were taking PrEP.
But our researchers have figured out how to help people understand that when it comes to protecting themselves against HIV, size doesn’t matter.
This is what we have learned.
- When people are on the move, move with them
Many of the people we help at the Pop Inn clinics are immigrants. They move across the country or to other parts of Africa to work or to find better jobs.
Migrant workers who have traveled between 40 and 110 km from their places of origin are 1.5 times more likely to contract HIV than those who do not move, according to a 2017 study published in the journal AIDS found.
As people move more, it also becomes more difficult for them to get PrEP conveniently.
For that reason, we established a society to bring service to people when they cannot come to us.
CareWorks is a private courier service that helps people manage their chronic illnesses by bringing HIV prevention medicines, antiretrovirals and self-test kits to people in hard-to-reach areas.
This partnership has paid off. Since we joined forces with CareWorks in June, 202 of our Pop Inn clients get their PrEP this way.
The service reaches people across the country, even in places that are off the beaten path or if someone doesn’t have an official address. In such cases, a person can give the courier a landmark of their place of residence, such as in front of a specific spaza store.
- Don’t give a man a fish; teach him to fish
People often do not believe they are at risk of becoming infected with HIV, which means they may not take the right steps to protect themselves. At Aurum, we have designed a screening tool to help people determine how likely they are to become infected with HIV.
PrEP is only useful for people who are HIV negative, so the first thing a client is asked to fill out on the form is their HIV status. (They are also going to take a test later.)
The rest of the questions on the checklist ask about how often someone has sex, whether they use any kind of protection, such as condoms, and whether they know their partner’s HIV status.
Once people have filled in all these details, a nurse will sit down with them and explain how HIV infection is spread and what kind of behavior might lead to a higher chance of contracting the virus. The health worker will also give the person an information brochure on how PrEP works.
We have learned that giving people the explanations they need to make their own decisions in their own time, rather than simply telling them what to do, goes a long way toward helping them take medicine. For example, our nurses not only discuss the benefits of taking the pills, but also discuss the side effects people may experience when taking PrEP, which can include headaches, tiredness, nausea, and bone pain.
Health workers explain what people can do to alleviate these side effects, such as taking pain relievers or having a checkup at the clinic.
We found that the more informed people became, the less concerned they were about the size of the pill, for example. We also give them tips on how to swallow it so it doesn’t get stuck in their throat.
- Help people help each other
Our Pop Inn clinics have support groups called adherence clubs. They meet once a month and are led by people who have been on PrEP for a while. Joining a group like this helps new starters stay on their medications and encourages them to return to the clinic regularly to get their pills so they don’t run out. It also helps that Aurum covers their transportation costs.
We have also found that a buddy system works well. People in adherence clubs are paired up with another person in the group so they can remind each other to take their pills or pick up their medicine at the clinic.
They can also ask our teams questions on WhatsApp or Facebook and make clinic appointments on these platforms.
- PrEP to adapt to people’s sexual lives
Since we started teaching people how they can reduce their risk of HIV infection, almost four times as many clients at our clinics are requesting PrEP. As of September 2019, 2,596 people were receiving HIV prevention pills from us; today we have 10,305 PrEP clients.
Also, fewer people are ordering HIV prevention pills that you take after possibly being exposed to HIV, for example, during unprotected sex. This is called post-exposure prophylaxis, or PEP, and for the medication to work, it must be taken within 72 hours of possible exposure to HIV; the sooner it is taken after possible exposure, the better it will work. At our eThekwini clinic, for example, the number of PEP requests has nearly halved this year, from over 50 in 2021 to just 27 in 2022.
We also found that many people, especially those who are not in long-term or stable relationships, prefer to use PrEP “on demand,” which means they take two doses of the medication 24 hours before intercourse and one tablet each day afterward for the next few days. next two days. (This is sometimes called the 2+1+1 method.)
Since the on-demand PrEP project began in 2022, more than 700 people have received pills this way at our clinics.
Although the shorter course of treatment is easier for people to take, there is still a chance that they will forget one of the pills, which could reduce the protection they would get from the drug. That is why we encourage our 2+1+1 patients to also join an adherence club and the buddy system.
Whats Next?
The most important thing about this project is that people are willing to take care of their health; they just need the right information and a supportive environment.
Since we began sharing educational messages on community radio stations like GugsFM and social media platforms like Facebook in April, we’ve reached more than 100,000 people, our data shows.
It is much more effective, and also cheaper, to prevent HIV infection than to treat it; Studies from around the world confirm this.
This story was produced by the Bhekisisa Center for Health Journalism. Sign up for the Newsletter.
Maria Sibanyoni She is the Aurum Institute’s lead technical advisor for all of the organization’s projects for sex workers, men who have sex with men, transgender women, and young women.
jAcqueline Pienaar is technical director of the institute. She is a public health specialist with experience in sexual and reproductive health and HIV prevention and treatment.
Vuyolwethu Ncube is a research coordinator at the institute. Her interests include violence against women and public health.
Matshidiso Chabane is a clinical associate. She runs Tinstitute’s Pop Inn project for transgender women and men who have sex with men.
