Abstract
In recent times, there have been coordinated efforts across the world to rein in new HIV infections. It should, however, be noted that despite the said efforts, HIV continues to be a major health concern across the globe. Further, it should also be noted that the decline in new HIV infections across the globe has decreased minimally over the last one decade. This is an indication of the need for further assessment and evaluation of the various prevention approaches that have been put in place over the last few years. In essence, this text concerns itself with pre-exposure prophylaxis (PrEP) with reference to the prevention of HIV amongst those with substantial risk of contracting HIV – specifically sex workers. PrEP remains one of the HIV prevention measures whose evaluation has indicated significant protection rates in not only real-life, but also clinical trials.

Pre-Exposure Prophylaxis to Prevent HIV Infection

Current statistics indicate that HIV is still a serious global public health concern. This is more so the case given that recent estimates indicate that as of the year 2017, approximately 37 million people from across the world were living with the disease (Avert, 2018). It is important to note that a quarter of the 37 million persons were not aware of their HIV status. Some of the basic measures that have been implemented in the past in an attempt to rein in HIV include, but they are not limited to, the utilization of condoms, limiting of the number of persons one has sex with, and undertaking a HIV test with one’s partner prior to having sex. However, in recent times, PrEP has emerged as a valid HIV prevention option especially for persons whose risk of infection is deemed to be relatively high. The relevance of this prevention approach cannot be overstated given the “renewed concern that the annual number of new infections among adults has remained static in recent years”, with new infections from across the world having “declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017” (Avert, 2018).

Background

Pre-exposure prophylaxis (PrEP) does not have an assigned definition. In that regard, therefore, no standard definition of PrEP has been offered over time. However, a deconstruction of the three words that make up the phrase (i.e. pre, exposure, and prophylaxis) clearly indicated the nature of PrEP. While pre means prior (or before), exposure is used to denote the action of being subjected to or being vulnerable to something (in this case the HIV virus). Lastly, prophylaxis could be defined as the course of action (i.e. treatment) taken with an aim of preventing disease. Therefore, in essence, PrEP “is a daily course of antiretroviral drugs (ARVs) that can protect HIV-negative people from HIV before the potential exposure to the virus” (Avert, 2018). This is the definition of PrEP that will be adopted in this text.

It should be noted that studies conducted in the past have clearly indicated that when taken on a regular basis and as directed, PrEP happens to be “very effective and reduces the chances of HIV infection to near-zero” (Avert, 2018). It is for this reason that PrEP have variously been referred to as the most promising approach to HIV tackle at present (Drowos, 2019). It should, however, be noted that global efforts to minimize the HIV burden ought to be founded on the analysis of the most prudent delivery avenues that would yield maximum impact among those with substantial risk of contracting HIV – specifically sex workers. This is more so the case given that PrEP is essentially a HIV prevention approach that only works for persons who are HIV negative and are on PrEP prior to their exposure to the virus. For this reason, the discovery/discernment of persons at the highest risk of acquiring HIV and, thus, for whom PrEP would be the most ideal prevention alternative is key. According to the Centers for Disease Control and Prevention - CDC (2019), “a combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada®, is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who’s positive.” As CDC further points out, numerous research studies have in the past clearly indicated that when used as directed, PrEP happens to be very effective. Its effectiveness, however, dramatically reduces when it is not taken as prescribed.

Literature Review

In the U.S. alone, there are approximately 1.2 million people living with HIV - with more than 38,000 new infections having been reported in 2006 alone (Drowos, 2019). On the other hand, in the U.K., it is estimated that a minimum of 100,000 are living with HIV (The Converstion, 2018). In 2018, the U.K. reported a total of 6,000 new infections (The Conversation, 2018). This...…be different in various states. At present PrEP is covered by Medicaid in states such as Florida and New York. For those persons who do not have private health insurance, there are various alternatives that they could explore so as to access PrEP at cheaper prices. These include, but they are not limited to; clinical trials and Gilead’s prescription assistance programs.

In seeking to further enhance the uptake as well as adherence to PrEP in this category, we ought to heed to two lessons from South Africa’s oral PrEP rollout for sex workers. As WHO (2018) observes, there happens to be a strong correlation between the effectiveness of PrEP in the prevention of HIV and adherence to the same. As a matter of fact, “the main predictor of the effectiveness of PrEP is adherence” (Fadul, 2016). A recent study indicates that “participants who engaged with daily administration only 50% of the time, had a 50% reduction in the efficacy of protection” (The Conversation, 2018). Towards this end, according to Bhavaraju and Uribe (2019), there is need to meet sex workers at their work stations so as to guarantee both access and uptake. This could be inclusive of visiting sex workers in brothels and restocking their PrEP as well as other relevant essentials such as condoms and HIV test kits. The other approach involves the establishment of a network of support services involving peer educators, counselors, etc. This provides sex workers with a point of reference with regard to their most pressing concerns.

Conclusion

Global efforts to minimize the HIV burden ought to be founded on the analysis of the most prudent delivery avenues that would yield maximum impact. In the final analysis, it should be noted that PrEP ought to be seen as an additional tool in the war against HIV and not as the only option in efforts to contain new infection rates – particularly amongst those with substantial risk of contracting HIV. As it has been indicated above, PrEP is not 100 effective in the prevention of HIV. Further, it does not in any way provide a cure for the HIV virus. For this reason, to definitively win the war against HIV, there is need to combine PrEP with other HIV prevention efforts, i.e. safe sex practice. If this is done, then PrEP will be a true game changer as far as our approach to the prevention of HIV is concerned.

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