When he won’t say yes to a condom, maybe you should say yes to this pill

This tablet can help to protect the country’s young women from contracting HIV.
The sun begins to set as Alwande Khoza* returns home from her second clinic visit in just over a week. She lives in a student commune in a quiet Durban street.

It’s a two-minute walk from the Steve Biko campus of Durban University of Technology where she’s a second-year business administration student.

It’s the last week of October. Most of Khoza’s peers are busy with their final exams as the academic year draws to an end. But Khoza, 20, has other pressing matters on her mind.

“Yoh! This pill is very big! How am I going to swallow it?” she asks herself. She’s holding a tablet, about twice the size of a Panado pill, in her hand.

Khoza grabs a glass of water, places the blue pill on her tongue and tries as hard as she can to swallow it. With the help of a few big gulps, she manages to swill down the 2cm tablet.

Khoza isn’t sick.

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But every night at 9 o’clock, for the next few years at least, she will be taking this pill to help her stay HIV negative.

The HIV prevention pill is here, but will women take it?
Khoza is one of 524 young women using an HIV prevention pill as part of a demonstration project being conducted by the Centre for the Aids Programme of Research in South Africa (Caprisa) in Durban.

The study began in March last year and will continue until the end of May 2018, Caprisa scientists Quarraisha Abdool Karim and Pamela Gumbi explain.

In 2015, South Africa became the first African country to approve the use of pre-exposure prophylaxis (PrEP) for HIV. The only other country that had done so at the time, was the United States.

PrEP allows people at a very high risk of contracting the virus to lower their chances of getting infected by taking HIV medicine, according to the US Centers for Disease Control.

The HIV prevention pill, called Truvada, contains two antiretroviral ingredients, emtricitabine and tenofovir. These are the same ingredients of some of the pills that HIV-infected people use to control the virus in their bodies.

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When emtricitabine and tenofovir are used as a form of HIV prevention, Truvada is taken once a day at more or less the same time.

Khoza and other study participants were tested for HIV and other conditions, such as liver problems. That is why she went to the clinic twice in one week.

The Caprisa researchers want to find out how young women feel about PrEP and how committed they are to taking the medication correctly.

The study participants are mostly from KwaZulu-Natal. “Most of the 705 volunteers are men and women between the ages of 18 and 30 years — the women make up 75% of the participants,” says Abdool Karim. “We’ve also had a lot of interest from younger women between the ages of 15 and 17 years and we are awaiting regulatory approval for their inclusion.”

Only people who are HIV negative can take Truvada. Tenofovir is excreted from the body through the kidneys. A medical professional therefore has to test that someone’s kidney function is normal and monitor them while they are taking PrEP, because it could sometimes affect their kidneys, according to 2014 study published in the journal Aids.

The more correctly someone takes PrEP, the better the pill works at preventing HIV infection. Studies have shown that PrEP can reduce the risk of contracting HIV by up to 96%.

Because men and women are biologically different, PrEP doesn’t work the same in their bodies. A 2015 study published in the Journal of Infectious Diseases showed that women who fail to take the pill every day have a higher chance of contracting HIV than men who have sex with men and skip doses.

The researchers found that 10 times more Truvada is retained in the rectum than in the vagina. As a result, women need a higher concentration of the pill in their bodies than men for the same level of protection.

Six to seven pills a week reduced women’s chances of contracting HIV by 92%, whereas two to three pills a week decreased men’s chances between 75% and 90% of getting infected with the virus.

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Young women at risk
The national health department provides Truvada for free to about 2 000 sex workers at 14 pilot sites. In June the department started to provide the pill to men who have sex with men at three sites. According to Yogan Pillay, deputy director general for HIV, the department is monitoring five demonstration sites offering PrEP to adolescent girls and young women.

Several studies have shown that sex workers and men who have sex with men, along with young women between the ages 15 and 24, are being infected with HIV at a faster rate than the general population.

South Africa had almost 500 000 new HIV infections in 2012, the latest Human Sciences Research Council national HIV household survey found. About a quarter of the new HIV infections occur among young women.

The survey also showed that condom use among women in this age group decreased from 67% to 50% between 2008 and 2012 at their last sexual encounter.

A 2016 Caprisa study, published in The Lancet HIV journal, found that one of the biggest reasons young, disadvantaged black women contract HIV at a faster rate than their male peers is a result of intergenerational sex — where young women have sexual partners who are on average eight years older than them.

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