By Malik Jjingo
In efforts to end the spread of HIV by 2030, researchers have called upon the government to support the increased uptake of new innovations that have been proved to be effective in protecting people against contracting the HIV virus.
Preventive measures such us PrEP medicine (Pre-exposure prophylaxis) and Post Exposure Prophylaxis (PEP), virginal ring and Injectable PrEP can be a game changer in the fight against HIV/AIDS if their use is scaled up in the country according to experts.
Researchers led by Dr Jonathan Kitonsa of Medical Research Center/UVRI Masaka Centre made the call while addressing Health and Science journalists under their umbrella Association Health Journalists Network – Uganda (HEJNU) during a science café about HIV/ AIDS at Tropic inn Hotel in Masaka city.
Dr. Kitonsa explained that there is still a challenge of attitude and knowledge gaps among communities about these new innovations that have been discovered by researchers yet they have been proved to be effective in asking the public to embrace them.
He noted that though PrEP was introduced in the country in 2017 its uptake is still relatively low among individuals at a high risk of contracting HIV who are also known as key population such as commercial sex workers, people who are frequently getting STIs, those with challenges of using protection,transgender, serodiscordant couples, intravenous drug users and prisoners among others urging government to invest in its increased uptake and availability to the last users at all levels.
Kitonsa said increased awareness and advocacy about these new modalities and full government support by making these drugs available will increase its uptake hence boosting the fight against HIV if Uganda is to attain the goal of ending new infections by the year 2030.
“There is still a lot of stigma among individuals that need PEP and PrEP which sometimes bars people from taking these tabs, thinking that they will be perceived as HIV/AIDS victims since the drugs have packages similar to that of ARVs, this can be reduced with increased awareness among communities that is why such engagements like science cafes are good initiatives’’, he added.
Dr Kitonsa however raised concerns over the inconsistency of users of PrEP and PEP which he said affects its effectiveness asking people to always be consistent if they start using these drugs to get effective results.
’’ When an individual is enrolled on PEP and PREP, they have to ensure that they take it wholesomely as prescribed but we have found that some people end up losing interest after some time which affects the effectiveness of the drugs, this tendency should end among users, though some users at times blame inconsistencies on access to these drugs which are not well distributed as other preventive measures such as condoms”. He noted.
Masaka District Health Officer, (DHO) Dr. Faith Nakiyimba, said that Masaka district is still stuck with the challenge of HIV/AIDS saying that Masaka is among districts that have high HIV prevalence rate in the country.
She said Masaka is a center of attraction of people from all walks of life since it’s a business hub for the region on top of being a route to neighboring countries such as Tanzania and DRC Congo.
The various economic activities such as fishing due to the existence of waterbodies makes it challenging to have the numbers of new infections reduced in the district since people on lake showers are very mobile and complacent.
Dr. Nakiyimba further revealed that currently Pep and PrEP have been spread down to healthy centers, III and IV in efforts to increase its accessibility since many have always complained about these drugs being inaccessible.
Researchers are now also mooting for other alternative methods that have been adopted by other regions in the world in response to end the spread of HIV
The Vaginal ring, that resembles a contraceptive ring has been confirmed to reduce 35% incidence in trials and with proper adherence safety increases to more than 50 %, this if taken up it can be a good tool in protecting women from getting infected.
The injectable PrEP is another method which is a long-lasting form of PrEP and according to experts this will address the challenge of adherence. Injectable PrEP is administered 4 weeks apart followed thereafter by an injection every after 8 weeks. Research shows that it is 79% more effective than daily oral PrEP in preventing HIV acquisition among heterosexual men and women.
Dr Shamim Ssendagire, a social scientist, urged the government to make these methods available in all public health facilities and selected private, health facilities, drugstores, adding that efforts should also be made to make them available in prisons, among other places where high spread of HIV has been observed.
“A combination of the new and existing preventive alternatives, if well used, can save the next generation from HIV if we address the challenge of stigma that is still associated with use of available preventive measures” Dr Ssendagire added.
Posiano Sserwadda, a peer leader of youths living with HIV/AIDS, at Uganda Cares Masaka center, said people have varying perceptions about the preventive measures, especially drugs, asking the the government to expedite the process of having alternative means such as the virginal ring and the PrEP injection rolled out.
There is need to do more advocacy campaigns to promote PrEP use for it has been proved to work, address stigma by putting new options closer to people to be accessed in private facilities, strengthen peer groups of all ages since children, youths and adults have varying perceptions about treatment and preventive measures.
Records from the UNAIDS report from 2020, indicate that at least 570 young women aged 15- 24 acquire HIV/AIDS every week in Uganda. In Masaka, the prevalence is at 11.1% among adults aged 15-49, 12.9% among females and 8.6 % among males.
Uganda adopted oral PrEP in 2017 and it has since rolled out in a phased- funded approach. Since 2017, oral PrEP has been scaled up from 6 sites in 4 districts to 351 sites in over 65 districts across the country.
By the end of June 2022, over 250000 clients had initiated oral PrEP. However, despite these achievements, there have been challenges and this has made the uptake stagger at 60% among those eligible and only 20% of those who initiated oral PrEP continue to take it.