Why young SA women have extra PrEP in their step
But despite evidence that HIV pre-exposure prophylaxis works, many still can't access it
When Gcobisa Madlolo isn’t modelling or tending to her young twins, she is teaching young women about how to protect themselves from HIV.
Madlolo, 25, from Johannesburg, is one of the young SA women who are taking pre-exposure prophylaxis (PrEP). She considers herself lucky to have access to the HIV-prevention programme.
“Some of the women that I come across say they don’t want PrEP because it’s a pill for girls who sleep around,” Madlolo said in Spain last week.
“Others say their families will think they are HIV-positive if they take an antiretroviral pill, but for me, taking this pill has been so liberating. Not only does it give me freedom to take control of my health, but taking it every day will give me an opportunity to see my four-year-old twins growing up.
“I don’t have to worry that I may contract HIV and not live long enough to see them through.”
Madlolo was in Madrid to receive the fifth Omololu Falobi Award for Excellence in HIV Prevention Research Community Advocacy. The award, presented to her at the HIV Research for Prevention (HIVR4P) gathering, is given by a group of advocacy organisations that focus on HIV prevention in memory of the late Nigerian HIV activist.
The Johannesburg mother, an early adopter of daily oral PrEP, became an advocate for the prevention programme two years ago, after she joined the Empower (Enhancing Methods of Prevention and Options for Women Exposed to Risk) study.
The study was aimed at developing simple, scalable, evidence-based interventions, adapted for local use. Her commitment to finding interventions that work for herself and other young women became something so dear to her heart that when the study came to an end last year she transitioned into another project, Power (Prevention Options for Women Evaluation Research), which helps to inform the introduction of oral PrEP among African women.
She is a member of a group at highest risk of contracting HIV. Women from 15 to 24, and girls between 10 and 19 in particular, account for a disproportionate number of new HIV infections.
In 2016, new infections among young women were 44% higher than among young men. In eastern and southern Africa, young women made up 26% of new HIV infections, despite only accounting for 10% of the population.
In 2017, SA became the first country on the continent to register an antiretroviral, Truvada, to be used as an oral PrEP by people who do not have HIV, to prevent them from becoming infected.
The idea behind PrEP has been to target populations where new infections remain consistently high. These include sex workers, men who have sex with men, those who inject drugs, and young women.
Researchers say introducing PrEP to young women has not been easy, due to pressure from intimate partners and family members.
Speaking at the conference, Elzette Rousseau-Jemwa, from the Desmond Tutu HIV Foundation, who is part of the Power study, said about half of the 1,000 women who had enrolled stopped taking PrEP within a month.
“Some of them say taking the pill every day when they are not sick is a burden. Others have cited side effects as the reason, even though sometimes the side effects are associated with using a contraceptive,” she said.
“Some young women said they stopped PrEP because of issues either with their partners and broader communities or their families.”
Partners were often suspicious that taking PrEP meant their lovers were being unfaithful, while family members associated ARVs with the stigma of being HIV-positive.
Rousseau-Jemwa said it had been encouraging that one in five women who discontinued PrEP resumed it again within the first three months.
Dr Sinéad Delany-Moretlwe, director of research at the Wits Reproductive Health and HIV Institute, said that while PrEP was offered to everyone who considered themselves at risk of HIV, the rollout had been sluggish and very few clinics offered the treatment.
People who needed PrEP often had to get it from research sites or clinics that run specialised programmes.
“We find that there is some level of discomfort when it comes to visiting such clinics, as people associate these facilities with the programmes they offer, which are still largely stigmatised by society,” she said.
Professor Linda-Gail Bekker, who heads the Tutu foundation and was also awarded the Desmond Tutu Award for HIV Prevention and Human Rights for her “outstanding work” in HIV prevention, said it was time for governments to deliver PrEP.
Bekker is known for user-friendly clinics that offer services to high-risk groups, such as young people, particularly young women and girls, and men who have sex with men.
“The science is now clear that Truvada significantly reduces the risk of HIV infection. This evidence should make PrEP available quickly to all those who could benefit, but global access to PrEP remains very limited,” she said.
Meanwhile, Madlolo says she is going to use her recognition to “go out there even more ... where young women have very limited resources. I want to inspire and encourage them to make the right health choices. The key to their health is in their pockets.”