Uganda Government right to reject proposed HIV ‘prevention drug’

By Irene Nabusoba

On August 26, 2013, the New Vision published an article about a drug that can be taken before sexual intercourse as a prevention tool under a strategy called pre-exposure prophylaxis. This proposed HIV preventive pill, is a combination of tenofovir and emtricitabine commonly referred to as Truvada’.

The article titled, ‘Government rejects HIV prevention drug,’ quoted Dr. Alex Ario, the programme coordinator of Antiretroviral therapy in the Ministry of Health (MoH) explaining how there was a proposal to introduce the controversial strategy in Uganda on grounds that it will help reduce new HIV infections.

I can’t thank the Ministry of Health enough on this move because the strategy risks destroying all the achievements we have registered as a country in the HIV fight, especially at a time when we are already struggling.

You recall that Uganda once made strong strides in the HIV fight under the Abstinence, Be faithful, or use Condoms (ABC) strategy to the extent that we became a global yardstick.

But time dictated that the campaigns needed re-enforcement from different fronts in the face of globally increasing research advances, like emergency of Antiretroviral (ARV) medicines that have given patients a second lease on life, putting the death-row fears associated with HIV and AIDS in the back row. These ARVs have also made it possible to prevent mother to child transmission of HIV under PMTCT, and now Option B+ strategy.

Then we rolled out safe male circumcision (SMC) with its benefits.

However, while we embrace everything possible to prevent HIV infections in the absence of a vaccine, too many approaches may undermine the very efforts and progress, like introduction of the proposed ‘prevention drug’.

ARVs have been hailed as ‘wonder/miracle’ drugs but without proper HIV counselling and testing, drug adherence and responsible sexual behaviour, we are witnessing a wave of increasing new HIV infections. National reports show that Uganda's HIV prevalence rates have increased from 6.4% in 2005 to 7.3% in 2012.

Reason? ‘Complacency’ is the chorus. The Uganda AIDS Commission and several policy makers have repeatedly been quoted in the media, attributing increasing risky sexual behaviour and consequent rise in HIV infections to complacency. Apparently, the public no longer considers HIV as a big threat because of availability of drugs.

And now we want to tell the increasingly ‘complacent’ population that they now have a ‘temporary’ vaccine under the proposed ‘prevention drug’!

Take an example of SMC, where many think removal of the foreskin is definite protection against HIV infection, rushing into risky sex long before they even heal, with little regard for the fact that the medical procedure simply minimises risk.

We risk shooting ourselves in the foot by proposing this drug as a preventive tool. The public tends to look to medicines for healing instead of prevention. Besides, there are imminent fears of ARV resistance because of poor adherence yet people have to commit to taking this drug every day lest they compromise even the natural immunity.  If the HIV positive ones have challenges adhering well-knowing their life depends on the drugs, what of healthy fellows?                                     

Thanks to government efforts, half of HIV positive Ugandans that are eligible for ARVs can now access them. Let us ensure that the remaining half that still have challenges accessing ARVs get them by reserving treatment to improve and prolong life for the HIV infected/exposed.

After all, research by the World Health Organisation even shows that early, effective treatment minimises risk of HIV infection by significantly lowering the viral load.  

The writer is a Public Relations Executive with Quality Chemical Industries Limited.