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KENYA: Providing ARVs to HIV-Negative People Will Strain Resources

Miriam Gathigah

NAIROBI, Jul 21 2011 (IPS) - When Lucy Omollo found out that her husband was HIV-positive six years ago, the couple thought the best way to prevent her from becoming infected with the virus was not to have sex.

“For the first three years we never engaged in sex, but I gathered courage and we began using condoms,” Omollo says.

But Omollo is well aware that this is not 100 percent safe. “Every encounter still fills me with fear, the condom could burst and my fate would be sealed,” explains Omollo.

But now she has some hope. Omollo and other Kenyan couples in discordant relationships – where one partner is HIV-positive and the other is HIV-negative – have welcomed findings of a recent study that found taking a daily dose of antiretrovirals (ARVs) reduced ones chances of contracting HIV.

While it is good news, it is uncertain whether the Kenyan government has the resources to provide ARVs for these HIV-negative people as the country is still struggling to provide treatment for large numbers of HIV-positive people.

“I am hopeful that an antiretroviral pill taken daily could reduce my chances of getting infected even if the condom were to burst,” Omollo says.

Peter Mathenge, whose girlfriend is HIV-positive, agrees.

“It is very stressful constantly wondering whether every sexual encounter with your girlfriend has left you infected with HIV. It puts a strain in the relationship, if an ARV pill taken daily can be my additional protection, I think it would change the lives of many of us living with HIV-positive partners,” explains Mathenge, who has been in a relationship with his girlfriend for the last two years.

The findings seem like a slow but sure shift from curative to preventive measures in the fight against HIV.

Africa carries the greatest burden of HIV infections and deaths resulting from AIDS. It is also home to more than 15 million children who have lost one or both parents to HIV/AIDS and whose lives will never be the same again.

But years of fighting the disease have not drastically reduced the number of those infected in many African countries. Neither has society’s improved level of HIV/AIDS awareness made a difference to the high infection rate. This comes as the Kenyan ministry of special programmes says that the number of new infections have risen to a high of 100,000 a year.

“(Despite) the devastating impact that HIV has had on people’s lives and development as a whole, a lack of significant positive behavioural change can be construed to mean that people are still not taking the disease seriously in spite of the fact that we are all either infected or affected,” says Dr. John Ong’ech, a gynecologist and HIV specialist in Nairobi.

The Kenya National Aids Control Council, a corporate body which works towards an HIV-free society, has confirmed that being in a stable sexual relationship, either homosexual or heterosexual, increases ones chances of being infected as unfaithful partners continue to widen the web of infection as they veer off into highly risky sexual behaviour.

“We now know that close to half of all new infections come from people within steady unions and maybe it will be most logical to focus on such groups and come with effective preventive measures in which the non-infected partners are also taken into full consideration,” explains Girmay Haile a Senior Institutional Development Adviser at UNAIDS.

Various studies, the most recent and outstanding having been carried out in both Kenya and Uganda, have been touted as a breakthrough in the fight against HIV/AIDS. Similar studies are being conducted in Tanzania, Malawi and South Africa.

In Kenya, the study dubbed the Partners PrEP trial, was carried out among 4,758 HIV discordant couples at Kenya’s largest referral hospitals, Kenyatta National Hospital and Moi Teaching and Referral Hospital, in conjunction with the Kenya Medical Research Institute and the University of Washington in the United States.

The results of the study released on Jul. 14 proved that taking a combination of antiretrovirals (tenofovir and truvada, or a combination of tenofovir and emtricitabine) already in use in Kenya for treatment of HIV, can reduce the risk of HIV infection by up to 73 percent.

“It is prevention that will win us the war against the epidemic in the absence of a curative treatment… The research to find a curative measure is still underway,” explains Haile.

He adds: “If you look at national responses and the prevention revolution that is required to reduce new infections to manageable proportions, and then to zero infections, within a short period – it is the way to go.”

Dr. Nelly Mugo, a gynecologist in Nairobi and a leading researcher in the PrEP study, is quick to warn that ARVs should be used in combination with other methods, such as male circumcision, which has been proven to reduce HIV infection by at least 60 percent, and condoms.

“The drugs taken daily by the participants is a significant preventive therapy,” she emphasises.

As various stakeholders and medical experts rally behind the PrEP trial, providing ARVs to HIV-negative people in Kenya will greatly strain resources that are yet to cater for those already infected. In Kenya at least 400,000 people of the 1.4 million people infected are on ARV’s.

The Kenyan government also only provides ARVs to those with a CD4 count of at least 200. This is opposed to the World Health Organization guidelines that say people with a CD4 count of at least 350 should be on ARVs.

The strain to cater for the already high number of HIV-positive people in need of ARV’s is a challenge that needs to be acknowledged.

“When we talk of HIV-negative persons accessing and using ARVs, it means (a) much greater burden on available resources to respond to the epidemic. However, this latest finding has created a momentum towards narrowing further and preparing to address the pockets of new infections in a much more focused and effective manner,” Haile says.

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