Slut-shaming blunts a vital weapon in anti-HIV armoury

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Slut-shaming blunts a vital weapon in anti-HIV armoury

The HIV-prevention pill needs its own protection from prudish fearmongering

Journalist


When Yamkela Mqhumshana heard about a pill that protects women from HIV, she jumped at the opportunity to be part of a group trying it.
“As a young woman who is not in a long-term relationship, I always worry, what if I meet a guy who will infect me with HIV? With this pill I could now enjoy sex without worrying about getting the infection,” said the 24-year-old from Cape Town.
But after a few months on HIV pre-exposure prophylaxis, or PrEP, the mother of one said she felt discouraged, having been labelled “promiscuous, HIV-positive and a cheater” by her community in Masiphumelele, near Fish Hoek.
“These comments get to you and put you down … so that in the end you end up defaulting on treatment just to get out of trouble,” Mqhumshana said.
Her experience is not unusual, and the results of the study she was involved in suggest young women showed more interest after being exposed to a marketing campaign that emphasised PrEP’s positives, rather than fearmongering.
One of SA’s leading HIV experts, Desmond Tutu Foundation head Linda-Gail Bekker, has now warned the PrEP rollout could fail if it focused on HIV risk and only targeted so-called high-risk populations.
Writing in The Lancet, Bekker and Rivet Amico, an expert in health behaviour and education from the University of Michigan in the US, said PrEP should be “demedicalised” and marketed with a focus on protection and pleasure.
Mqhumshana was part of a 12-month “3Ps” (perception, partners, pills) study that assessed PrEP acceptability and adherence among 200 HIV-negative young women in Cape Town.
In 2016, women aged 15 to 24 accounted for 37% of new infections, about four times greater than men their age.
To tackle this problem, in 2017 SA became the first African country to offer young women and adolescent girls an antiretroviral, Truvada, after research showed it was safe and effective at preventing HIV.
Mqhumshana said she quickly became disheartened after joining the 3Ps study.
“My boyfriend became very suspicious and kept on asking whether I’m cheating on him, and why I am on this pill when we both tested HIV-negative.
“Others, including some of my friends, started talking about me on the side, saying I was using ARVs so that I could sleep around. If I went to friends or family members where PrEP is not well-known, people would ask me why do I take an ARV drug if I’m not HIV-positive?”
Bekker said people like Mqhumshana were experiencing an unintended consequence of the PrEP rollout strategy.
“Positioning PrEP as being a rigidly offered risk-reduction approach for certain populations will limit its effectiveness and create misconceptions that will take time, effort and resources to correct. PrEP needs to be nested within health promotion more generally,” she and Amico wrote.
Such an approach should focus on the advantages of PrEP, such as the control it gave users of their own health, and “the feeling of safety from HIV infection at all times”.
Bekker said there were already reports that PrEP had been denied to potential users on the basis that they were not “risky enough”, and warned that this approach could strangle its effectiveness.
“It is still very important for PrEP to reach the most at-risk groups, but the approach should be to make it attractive rather than stigmatising the groups’ behaviour or risk.”
Laura Myers, one of the 3Ps investigators, said marketing the prophylaxis with empowering messages, such as “PrEP gives you protection” or “Enjoy sex without worrying as much”, had positive spinoffs.
“Our challenge is figuring out how to convince young people, who feel healthy, to take a pill to prevent a condition [HIV] which they may not be particularly concerned about,” said Myers.
“It’s really important for anyone taking PrEP to understand that they have to adhere well for it to work. If you only take your pills now and then, like after having sex for instance, then you won’t have enough protection in your blood to keep you safe from HIV.”

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