Namibia approve the use of PrEP in HIV prevention

By Lahja Nashuuta

Windhoek – The  CD4 count (the number of blood cells in a cubic millimetre of blood) will no long be a criteria for one to get ARV treatment in Namibia as individual at substantial risk of HIV contraction will now be entitled to take pre-exposure prophylaxis (or PrEP).

In accordance with World Health Organisation 2015 Guidelines, PrEP is defined as the use of antiretroviral drugs before HIV exposure by people who are not infected with HIV in order to block or prevent the acquisition of HIV.

As part of the government efforts to reduce new infections, reducing Aids-related deaths and thereby increasing life expectancy, the Ministry of Health and Social Services 2016 National Guidelines has expanded the provision of PrEP to individuals at extensive risk of HIV acquisition as per the WHO prevention guidelines released in 2015.

Sarah Tobias, health programme officer at the Ministry of Health and Social Services, said PrEP was approved by the Namibia Medicines Regulatory Council in May 2017, and can be taken by any sexually active HIV-negative person at higher risk of acquiring HIV such as HIV negative people in relationship with a partner who is HIV positive, those with multiple concurrent sexual partners, history of inconsistent or no condom use or history of sex while under the influence of alcohol.

“You will agree with me that without a vaccine or a cure, the Aids pandemic will become unmanageable unless if we reduce drastically and quickly the transmission rate.

Thus PrEP is one of the additional prevention tools we can use for people who perceive themselves to be at substantial risk of HIV infection,” she said.

PrEP will be offered as part of the combination prevention package that includes HIV testing services, male and female condoms, lubricants, ART for HIV positive partners in sero-discordant couples, voluntary medical male circumcision and STI prevention and management.

Tobias said PrEP should not be considered as a cure for HIV and is not intended to replace the existing evidence-based HIV prevention strategies but it was introduced to close the gap left by those HIV existing prevention methods.

With regards to the people’s concern that people may increase risk activities as a result of new “sense of security” such as sex without a condom and having multiple sexual partners, Tobias said the available studies indicate the opposite, decreased risk behaviours such as lower syphilis incidence, fewer sexual partners and low rate of sex without condoms.

“Using PrEP as prescribed is paramount to its ability to reduce the risk of HIV infection.

Regular and daily use as directed, often referred to as adherence is understood as the primary factor in the effectiveness of PrEP,” she said.

She said this would address the possibility of drug resistance which, even though rare, can develop if not taken correctly as prescribed.

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