Men who have sex with men will soon be able to get the HIV prevention pill in Tshwane.
The HIV prevention pill, Truvada, combines two antiretroviral drugs. Studies have shown that, when taken daily as pre-exposure prophylaxis (PrEP), Truvada can reduce the risk of HIV infection in men who have sex with men by 86%.
As of April 1, men who have sex with men will be able to get PrEP from a Hatfield clinic in central Pretoria. The clinic is run by health advocacy organisation OUT LGBT Well-being, which already provides HIV prevention services, such as a needle exchange programme, to people at high risk of HIV.
In March last year, the national health department announced it would begin providing PrEP for free to about 5 000 sex workers at 10 sites to reduce new HIV infections. In December, the department’s deputy director general for HIV, Yogan Pillay, said young women as well as men who have sex with men were likely to be the next to get access to Truvada.
Men who have sex with men are more at risk of HIV because of a range of factors, including anal sex. A 2010 study published in the International Journal of Epidemiology found that the risk of contracting HIV through unprotected anal sex was about 20 times greater than that associated with unsafe vaginal sex.
High levels of stigma at health facilities also makes it more difficult for them to access healthcare.
The Anova Health Institute has been piloting PrEP for men who have sex with men since July 2015. As part of its programme, 400 men have been given a 12-month course of Truvada through Cape Town’s Woodstock Community Health Centre and Johannesburg’s Yeoville Clinic. As part of the project, Anova sensitised nurses on men’s issues and taught them to prescribe and monitor PrEP among men who have sex with men.
According to Anova senior clinical specialist Kevin Rebe, training nurses to understand the needs of men who have sex with men is imperative to overcome the stigma created by health workers’ limited knowledge.
He explains: “If [men] go to see a nurse at a public healthcare clinic, they aren’t screened for HIV prevention. They may be friendly but they are not asking about anal sex and aren’t competent to gauge what [men’s] needs are.”
Anova has also taught nurses in 250 public clinics to administer antiretrovirals and screening for sexually transmitted infections to men who have sex with men. Nurses were told how to prescribe and monitor PrEP as the country begins to expand access to PrEP.
Pillay says that in June the national health department will review progress in rolling out PrEP to men at the sites of Yeoville, Woodstock and Hatfield. This will inform the next wave in a national roll-out of the HIV prevention pill.
Anova’s chief executive officer, James McIntyre, says the department of health’s commitment to include men who have sex with men as a target population in the latest national HIV and tuberculosis plan promises to reduce new HIV infections.
The strategy was launched on Friday in Bloemfontein and proposes providing PrEP and increased screening for high-risk conditions such as rectal cancer and hepatitis B among men who have sex with men.
The trick, Rebe says, will be getting men to realise PrEP is for them.
“If you can’t convince communities that PrEP is for them, you won’t see any benefits.”