Abstract
Pre-exposure prophylaxis (PrEP) has proven to be highly effective in preventing HIV in uninfected persons when properly adhered to. East and Southern African countries that suffer from high HIV prevalence and incidence are increasingly adopting PrEP as an HIV prevention strategy for their high-risk populations, including for young women. Structural factors such as poverty, lack of education, and gender-based violence may compromise their PrEP uptake and adherence, however. Choice-disabled young women are most at risk of HIV infection and least able to apply HIV prevention choices. For successful rollout of this biomedical solution, we need structural interventions that address these underlying drivers of the HIV epidemic.
Résumé
Lorsqu’elle est bien suivie, la prophylaxie pré-exposition (PPrE) s’avère hautement efficace pour prévenir le VIH chez les personnes non infectées. Les pays d’Afrique de l’Est et d’Afrique australe aux prises avec des taux élevés de prévalence et d’incidence du VIH adoptent de plus en plus la PPrE comme stratégie de prévention du VIH dans leurs populations à risque élevé, en particulier les jeunes femmes. Les facteurs comme la pauvreté, le manque d’instruction et la violence sexiste peuvent toutefois compromettre l’utilisation et l’observance de la PPrE dans ces populations. Les jeunes femmes défavorisées sur le plan des choix sont les plus vulnérables aux infections à VIH et les moins capables de mettre en pratique les choix de prévention du VIH. Pour un déploiement réussi de cette solution biomédicale, nous avons besoin d’interventions structurelles qui tiennent compte des vecteurs sous-jacents de l’épidémie de VIH.
Similar content being viewed by others
References
Andersson N. Prevention for those who have freedom of choice — or among the choice-disabled: Confronting equity in the AIDS epidemic. AIDS Res Ther 2006;3(1):23. PMID: 16999869. doi: 10.1186/1742-6405-3-23.
Andersson N, Cockcroft A. Choice-disability and HIV infection: A cross sectional study of HIV status in Botswana, Namibia and Swaziland. AIDS Behav 2012;16(1):189–98. PMID: 21390539. doi: 10.1007/s10461-011-9912-3.
Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS (London, England) 2016;30(12):1973–83. PMID: 27149090. doi: 10.1097/QAD.0000000000001145.
AVERT. Averting HIV and AIDS [online]. Available at: https://www.avert.org/ (Accessed May 1, 2017).
McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet 2016;387(10013):53–60. doi: 10.1016/S0140-6736(15)00056-2.
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012;367(5):399–410. PMID: 22784037. doi: 10.1056/ NEJMoal 108524.
Celum CL, Delany-Moretlwe S, McConnell M, van Rooyen H, Bekker L-G, Kurth A, et al. Rethinking HIV prevention to prepare for oral PrEP implementation for young African women. J Int AIDS Soc 2015;18(4):20227. doi: 10.7448/IAS.18.4.20227.
BAISIV. Botswana AIDS Impact Survey IV (BAIS IV). Gaborone, Botswana: BAISIV, 2013.
Andersson N, Cockcroft A, Shea B. Gender-based violence and HIV: Relevance for HIV prevention in hyperendemic countries of southern Africa. AIDS 2008;22:S73–86. PMID: 19033757. doi: 10.1097/01.aids.0000341778.73038.86.
Roberts ST, Haberer J, Celum C, Mugo N, Ware NC, Cohen CR, et al. Intimate partner violence and adherence to HIV pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: A prospective cohort study. J Acquir Immune Deftc Syndr 2016;73(3):313–22. PMID: 27243900. doi: 10.1097/QAI.0000000000001093.
Koechlin FM, Fonner VA, Dalglish SL, O’Reilly KR, Baggaley R, Grant RM, et al. Values and preferences on the use of oral Pre-exposure Prophylaxis (PrEP) for HIV prevention among multiple populations: A systematic review of the literature. AIDS Behav 2017;21(5):1325–35. PMID: 27900502. doi: 10.1007/S10461-016-1627-Z.
Corneli AL, Deese J, Wang M, Taylor D, Ahmed K, Agot K, et al. FEM-PrEP: Adherence patterns and factors associated with adherence to a daily oral study product for pre-exposure prophylaxis. J Acquir Immune Defic Syndr 2014;66(3):324–31. PMID: 25157647. doi: 10.1097/QAI.0000000000000158.
Weiser SD, Leiter K, Bangsberg DR, Butler LM, Percy-de Korte F, Hlanze Z, et al. Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med 2007;4(10):e260. doi: 10.1371/journal.pmed.0040260.
Kagee A, Remien R, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: Challenges and potential ways forward. Glob Public Health 2011;6(1):83–97. PMID: 20509066. doi: 10.1080/17441691003796387.
Hargreaves JR, Bonell CP, Boler T, Boccia D, Birdthistle I, Fletcher A, et al. Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. AIDS 2008;22(3):403–14. PMID: 18195567. doi: 10.1097/QAD.0b013e3282f2aac3.
Author information
Authors and Affiliations
Corresponding author
Additional information
Acknowledgements: We thank Neil Andersson for his review of this manuscript.
Funding: RW is funded by the Fonds de recherche du Québec - Santé (FRQS) and the Lloyd Carr-Harris Foundation; DL is funded by the FRQS.
Conflict of Interest: None to declare.
Rights and permissions
About this article
Cite this article
van der Wal, R., Loutfi, D. Pre-exposure prophylaxis for HIV prevention in East and Southern Africa. Can J Public Health 108, e643–e645 (2017). https://doi.org/10.17269/CJPH.108.6254
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/CJPH.108.6254