Today the National Health Department and the South African National AIDS Council (SANAC) are expected to announce that at least 3,000 HIV-negative sex workers will be eligible to begin taking the combination antiretroviral (ARV) Truvada as pre-exposure prophylaxis (PrEP) to prevent contracting HIV. Truvada combines the ARVs emtricitabine and tenofovir.
The announcement is expected to make South Africa one of the first countries in the world to bring the latest HIV prevention science to those who need it most.
Large-scale clinical trials have shown that if taken daily, Truvada can reduce the risk of HIV infection by 90 percent in people at high risk for contracting HIV like sex workers or men who have sex with men.
SANAC and the department are also expected to announce that all HIV-positive sex workers will be eligible to start HIV treatment as soon as they test positive for the virus and regardless of CD4 counts in a model dubbed “test and treat.”
Currently, most people living with HIV must wait until their CD4 counts – a measure of the immune system’s strength – fall to 500 before they can start treatment.
Studies have shown that earlier treatment is better for people living with HIV – it may also help reduce new infections.
HIV-positive people who adhere to treatment long enough and well enough to bring levels of the virus down to very low levels in their blood are also less likely to transmit the virus.
The ARVs used in Truvada also form part of standard HIV treatment when combined with a third ARV. People who use PrEP will have to regularly test for HIV to ensure that they are switched to the three-drug regimens needed to avoid drug resistance should they contract HIV.
New study shows up to 70 percent of sex workers living with HIV
SANAC CEO Dr. Fareed Abdullah likened the concept of HIV treatment as prevention to measures many people take to stave off malaria while traveling.
“Before you go into a malaria area, you take a malaria drug with anti-malaria medication and it reduces the risk of malaria,” he told Health-e News. “In this case, we are offering sex workers an ARV taken once a day to reduce their risk of contracting HIV by 90 percent.”
Just like anti-malarial drug use, the use of ARVs for PrEP might not be forever for some people, added Wits Reproductive Health & HIV Institute Director of Implementation Science Dr Saiqa Mullick.
“PrEP provides an additional prevention option for those who are at risk for HIV,” said Mullick. “It works if people taking PrEP adhere to it and take it every day but they don’t need to take PrEP for the rest of their lives only during the period of their lives when they are at a significant risk.”
In September, the World Health Organisation endorsed test and treat for the general public and PrEP for people at high risk of HIV infection. Within weeks of the endorsement, the National Department of Health was holding meetings about how the two might be rolled out here, according to Mullick.
South Africa is the first country in southern Africa to register Truvada for use as PrEP, according to Mullick.
Three-year plan for sex workers to be unveiled today
The kind of high-level interest shown by Minister of Health Dr Aaron Motsoaledi and Deputy President and SANAC Chair Cyril Ramaphosa in curbing HIV among sex workers may be a rarity, as globally politicians tend to distance themselves from the stigmatised group.
“It’s rare for a country to have such high-level leadership dealing with HIV among sex workers,” Abdullah said. “It’s a sign that government is taking this very seriously and working with non-governmental organisations and the community to make sure that the right thing is done and done properly.”
In South Africa, the roll out of both to sex workers is part of a new three-year national plan to be unveiled today to address HIV prevalence rates that may be as high as 70 percent among sex workers, according to a new study to be released today.
Conducted in Cape Town, Johannesburg and Durban, the study also found low levels of HIV treatment and adherence among sex workers. Abdullah is hoping quick access to treatment after testing will help change that.
“If you manage to get a sex worker into a clinic, the last thing you want to do is postpone treatment,” said Abdullah, noting that the plan also provides for extensive outreach conducted by sex workers for sex workers covering everything from HIV and contraception to tuberculosis.
Cape Town-based sex worker rights organisation Sweat was one of several bodies representing sex workers that helped draft the new plan. The organisation has welcomed the plan’s adoption of international best practices, Sweat Human Rights and Lobbying Officer Nosipho Vidima told Health-e News.
Anova Health’s Dr Kevin Rebe currently runs a small Cape Town project providing PrEP to high-risk men who have sex with men. He adds that following the Medicines Control Council’s December registration of Truvada for HIV prevention, there is nothing stopping people in the private sector who believe they are at high risk for HIV from discussing PrEP as an option with their doctors.
Rebe added that as the cost of Truvada continues to fall, more medical aids might be willing to pay for its use as PrEP. According to Rebe, Truvada costs about R200 to R550 per month. – Health-e News.