Health Journalists Network in Uganda (HEJNU) Media Café on HIV/AIDS held at Tropic Inn Hotel in Masaka city on June 13, 2024
The Science Café Day
On Thursday 13 th June 2024, HEJNU Masaka Region coordinators Malik Fahad Jjingo and Davis Buyondo convened a half day media science café for journalists operating in the over 10 districts that make up Masaka region.
The highly attended engagement attracted over 21 journalists working for various media outlets including online publishers, radio, television and news papers among other media platforms that have passion for health and science reporting.
In attendance we had top researchers from Medical Research Council, (MRC) Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Masaka District Health Office, Social Scientist, a peer educator from Uganda Cares and Masaka Bureau Chief among other guests.
The science café discussed several other preventive measures including the Virginal Ring, and the Injectable PrEP and other strategies that have been put in place in the move to end the HIV/AIDS scourge by 2030.
The Panelists/Guests:
➢ Dr Jonathan Kitonsa Researcher MRC
➢ Dr Faith Nakiyimba Masaka District DHO
➢ Dr Shamim Nsimbi Ssendagire Social Scientist, Researcher MRC.
➢ Posiano Sserwadda Peer Educator Uganda Cares, HIV/AIDs Positive Person
➢ Al Mahad Ssenkabirwa Buerue chief Masaka
➢ Shamira Nabakooza – Raptourer
The Journalists:
- Nsubuga Robert, UBC/Maska City tv
- Nayiga Milly, Spancia FM
- Nakasita Emilly, CBS Emanduso
- Mwebaze Donozio, Karo FM
- Mildred Nakasanya Radio Buddu
- Davis Buyondo New vision
- Musisi Fred, Star FM
- Kayondo Margret Simba FM
- Mukisa Ronald Salt TV
- Namugwe Esther, Daily Monitor
- Derrick Juuko, Centenary FM
- Nalukwago Esther, Xtra FM
- Ssekweyama Ezekiel, Uganda Radio Network
- Nsubuga Muzafal, Cbs 88.8
- John Bosco Sseruwu, Bukedde paper
- Zainab Namusazi, Nile Post
- Malik Fahad JJingo, Radio One
- Maurice Matovu, Central update/Entebbe Post
- Nanyomo Phiona, Bukedde Radio
- Kizza Bonny, TOP TV
Malik and Davis welcomed the participants and the speakers to the café and briefed the gathering about the activities of HEJNU and asked the journalists to produce stories out of the meeting as it is their key role they can play in the fight against HIV/AIDS if the country is to attain the goal to end HIV/AIDS by 20230.
Presentations
Faith Nakiyimba, the Masaka District Health Officer, gave the first presentation. She highlighted that some people have a negative perception of PEP and PREP because they believe that if they use it, they will be labelled as HIV/AIDS sufferers. Although some people are prevented from using PEP and PrEP because they share some components with ARVs, it has been shown to be a successful strategy in the fight against HIV/AIDS.
Some people have found it difficult to accept taking the drugs because of side effects like nausea, among others, according to Nakiyimba. However, some of the negative effects that people have complained about can also occur from using other drugs.
Dr. Nakiyimba, however, stated that in order to guarantee the effectiveness of any intervention, it must be used consistently and often. Therefore, she asked PREP users to make sure they continue taking their medication for the full prescribed duration. “We are trying our best to ensure that we fight stigma among the users of these protective measures because some people are still afraid to use them because the community stigmatises some of them. We have developed a system of following up PEP and PrEP users, though the uptake is still very low. We try to send the users SMS to remind them when their next dose is due and the next drug pick up,” she said.
She clarified that increasing the accessibility of PrEP and PEP in private facilities, as is the case with other preventative measures like family planning techniques and condoms, will revolutionise efforts to boost the usage of oral PREP and PEP, which she claimed is still extremely low. However, NakiyImba disclosed that the Masaka district health department, working with partners, has been able to provide PEP and PrEp in nearly all of the district’s health centres, including health Centre III and IV levels. This indicates that there is a need to increase uptake of these measures, particularly the injectable PREP, which has also been found to be more effective.
The second talk made by scientist Dr. Jonathan Kintons, a researcher affiliated with the Medical Research Centre (MRC). It focused on debunking myths and providing a deeper knowledge of the day’s topics, which included PrEP and PEP.
Dr. Kintonsa gave a presentation to the group on the groups of persons who are primarily intended to receive oral PrEP, characterising these groups as those who have a higher than average risk of HIV infection. The key group includes intravenous drug users, transgender individuals, persons with difficulties utilising protection, people who operate in the commercial sex industry, people who often contract STIs, and prisoners.
He started by providing a background to the subject.
▪ HIV and AIDS burden still high in Uganda, with a prevalence of 5.5% among adults 15-49 years, 7.1% among females, and 3.8% among males.
▪ Uganda adopted the HIV combination prevention strategy consisting of structural, behavioural and biomedical interventions.
▪ New HIV infections are still unacceptably high, even with the inclusion of oral PrEP in the combination HIV prevention strategy.
▪ 570 young women btn 15–24 yrs acquire HIV each week in Uganda (UNAIDS 2020 spectrum estimates).
PrEP is the use of ARV drugs by people who are HIV-negative to prevent HIV acquisition before potential HIV exposure.
Oral PrEP
▪ WHO recommends that oral Pre-exposure Prophylaxis (PrEP) containing Tenofovir (TDF) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention.
• The present guidelines support the use of TDF/FTC in combination for effective PrEP.
• Truvada is a pill that contains the following two medicines:
Emtricitabine: an ARV nucleoside reverse transcriptase inhibitor (NRTI)
Tenofovir disoproxil fumarate (tenofovir DF): another ARV nucleoside reverse
transcriptase inhibitor
Defining substantial risk of HIV infection
Substantial risk of HIV infection is defined as HIV incidence around or higher than 3 per 100 person-years
in the absence of oral PrEP (based on epidemiological context and individual risk assessment).
Identifying and offering oral PrEP to those at substantial risk leads to:
Great individual benefit, Strong epidemio-logical impact, Optimal investment in resources
Who is PrEP intended for?
PrEP should be considered for people who are HIV-negative and at substantial risk of acquiring HIV
infection. This includes:
▪ Key populations such as CSWs, MSM, users of intravenous drugs, transgender people,
prisoners, and serodiscordant couples, people who: get ffrequent STIs, have high
number of sex partners, have history of inconsistent/no condom use, use PEP frequently
▪ ANYONE who perceives himself or herself to be at substantial risk.
The health care provider should help individuals explore and assess their own risks, health, and
commitment to effective use to determine whether PrEP is an appropriate option
Oral PrEP and efficacy
Key point: Oral PrEP is highly effective if taken as prescribed.
The greater the adherence, the greater the efficacy
• In clinical trials overall, the reduction in risk of acquiring HIV was more than 90% when oral PrEP was used consistently.
• Some demonstration projects have observed no new HIV infections during oral PrEP use.
Oral PrEP: Event driven
For men
▪ Double dose 2–24 hours before exposure
ideally closer to 24 hours
▪ 1 dose as exposure continues
▪ 1 dose per day until 2 days after day of last potential exposure
For women
▪ 1 dose daily for 7 days before exposure
▪ 1 dose daily as exposure continues
▪ 1 dose daily for 7 days after last potential exposure
Dr Kintonsa also went ahead and discussed the alternatives developed to oral prep which he said are
also tested to be effective in the fight against the virus if they are used well and consistently .
What are the alternatives to oral PrEP?
• In 2021 and 2022, the WHO provided new HIV prevention guidance that includes additional options for PrEP: the dapivirine vaginal ring and long-acting injectable PrEP.
• These provide yet another opportunity to expand the available options for individuals in need of HIV prevention.
• PrEP ring and CAB-LA can be used discreetly and provide an opportunity to address challenges to effective use of oral PrEP faced by clients.
The vaginal (dapivirine) ring
▪ The dapivirine vaginal ring is made out of a flexible silicon that is easy to bend and insert. It looks a bit like a contraceptive ring.
▪ The ring is put into the vagina where it slowly releases the antiretroviral drug dapivirine to prevent HIV.
▪ After it has been inside the vagina for 28 days, it needs to be replaced.
▪ Ring reduced incidence by 35% in trials.
▪ This increased to more than 50% when given open label with better adherence.
Injectable PrEP (Cabotegravir CAB-LA)
▪ CAB-LA is an intramuscular injection long-acting form of PrEP with the first two injections
administered 4 weeks apart, followed thereafter by an injection every after 8 weeks.
▪ Injectable PrEP 79% more effective than daily oral PrEP (Truvada) in preventing HIV acquisition
among heterosexual men and women.
He further highlighted the situation and state of uptake of PREP and PEP In the country as follows.
▪ Uganda adopted oral PrEP in 2017 and has since rolled it out in a phased-funded approach.
▪ Since 2017, oral PrEP has been scaled up from six sites in four districts to 351 sites in over 65
districts across the country.
▪ By end of June 2022, over 250,000 clients had ever initiated oral PrEP.
▪ Despite these achievements, there have been challenges: oral PrEP uptake is at 60% among
those eligible, and only 20% of those who initiated oral PrEP continue to take it which he said is
a bit challenging asking the media to help the reseUganda adopted oral PrEP in 2017 and has
since rolled it out in a phased-funded approach.
▪ Since 2017, oral PrEP has been scaled up from six sites in four districts to 351 sites in over 65
districts across the country.
▪ By end of June 2022, over 250,000 clients had ever initiated oral PrEP.
▪ Despite these achievements, there have been challenges: oral PrEP uptake is at 60% among those eligible, and only 20% of those who initiated oral PrEP continue to take it.
Challenges related to uptake and continuation
▪ burden of daily pill taking and drug fatigue,
▪ poor access to the facilities that offer oral PrEP due to travel and transport challenges,
▪ the high mobility of some clients,
▪ forgetting to take the drug,
▪ fear of being seen taking drugs with packaging similar to that of ARVs used for treatment,
▪ lack of food,
▪ perceived low risk,
▪ lack of information, fear of side effects,
▪ poor counselling,
▪ negative attitudes of the service providers toward oral PrEP (e.g., thinking that it encourages transactional sex), and knowledge gaps. He also shared stories of some of real-life experiences about users of Prep that have faced critical responses from their colleagues after sharing their stories about the use of PREP.
Real life stories
▪ A woman who stopped using PrEP after experiencing side effects observed:
“My friends advised me to drop the drug (PrEP) after taking for 15 days. They (friends) asked, ‘what will you do when you catch HIV?’ Implying that I was taking ARVs when I was HIV negative yet it was meant for the HIV-infected and [it was not yet the] time for that” (woman, 37 years).
…………………
▪ “… They gave me a bottle of pills (PrEP) for one month, but I swallowed for only two weeks and stopped due to side effects. I was experiencing dizziness, headache, general body weakness, hunger (increased appetite) and vomiting. I had thought it was just one pill to take me for three months and did not know that I was to take it daily. It causes a lot of thirst and if you do not take lots of fluids (drinks), you are in trouble… I can never swallow it again. The truth is, if you do not have money, you should not swallow that drug (PrEP)” (woman, 22 years).
He concluded his remarks by giving take aways messages to journalists.
Take home messages
▪ PrEP has been proved to work and is widely available
▪ New options available beyond the pills
▪ Should be used as part of combination package
▪ Barriers to uptake and acceptability still many
The PLHIV Posiano Sserwadda also a peer leader of youths living with HIV/AIDS, at Uganda Cares Masaka center, said people’s perceptions about the preventive measures especially drugs asking government to expedite the process of having alternative means such as the virginal ring and the prep injection rolled out.
▪ The is need to do more advocacy campaigns to promote PrEP use since its has been proved to work.
▪ To address stigma the new options should be put more closer to people so that they can also be accessed in private facilities.
▪ Strengthen peer groups of all ages since children, youths and adults have various perceptions about treatment and preventive measures.
Al Mahad Ssenkabirwa , discussed with the journalists some of the story ideas they can get out of the topics, which were discussed by the speakers and applauded HEJNU and AVAC that powers the science cafés saying that continuous engagements of journalists with researchers not only creates good relations between the two groups but also gives journalist a chance of having experts they can run to address the challenge of false and miss information about several studies conducted by researchers citing PREP, PEP, virginal ring and the injectable PREP among other innovations made toward fight against HIV.