Prep comes as a pill taken daily. It reduces the risk of getting HIV from sex by about 99 per cent when taken as prescribed.
The first
time Fatuma took HIV prevention pills, she had constant diarrhoea. She also experienced heavy menstrual flow.
“So I
stopped,” she says.
She is a
sex worker in Mombasa and uses money from her trade to finance her degree at
the Technical University of Mombasa, and take care of her nine-year-old
daughter.
“From that
time, I started insisting on my clients to use condoms,” she says. But not all
complied. Some of paid more and had condomless sex.
Female sex workers (FSW) have the highest rate of HIV infection among key populations in Kenya.
In the context of HIV, key populations include sex workers, men who have sex
with men (18.2 per cent HIV prevalence)
and people who inject drugs (18.3 per cent).
At least 29
per cent of FSW are living with HIV, the National Syndemic Diseases Control
Council (NSDCC) says.
That means they
are four to six times more likely to be living with HIV than other women.
Omar
Mwanjama, a coast regional officer with NSDCC, encourages them to use Pre-exposure
prophylaxis (PrEP) pills given
freely in public hospitals, on top of condoms.
Prep comes
as a pill taken daily. It reduces
the risk of getting HIV from sex by about 99 per cent when taken as prescribed.
But few sex
workers have taken the advantage despite its proven efficacy. Researchers, who
included those from Partners for Health and Development in Africa last year found
that only 24 per cent of sex
workers in Nairobi took Prep, and only a third of these took it consistently.
A 2017 study among sex workers in Mombasa
indicated that despite their willingness to use Prep, a majority did not because
there were concerns about its potential negative side-effects.
NSDCC explains
that although some people may experience side effects that include headache,
weight loss, nausea, vomiting, and abdominal discomfort, these effects often
reduce or stop after a few weeks of taking the PrEP.
One
organisation is amplifying the NSDCC message.
The Coast
Sex Workers Alliance (Coswa) is a grassroots female sex workers-led organisation
that champions human and health rights of sex workers at the Kenyan Coast.
“We are
educating our members about the extremely high risks we face and why it is
important to protect ourselves,” says Elizabeth Siama, a Coswa director.
Sex workers
can collect condoms at the Coswa offices in Mombasa, but go for Prep at the nearby
public hospitals including the Tudor Level 4 Hospital.
She says at
least 34 per cent of sex workers have reported that they have been violated in
their lifetime. The forms of violence include rape, intimate partner violence, and
violence by the police especially when they try to report violence.
Female sex workers (FSW) have the highest rate of HIV infection among key populations in Kenya.
Kenya initiated
national scale-up of pre-exposure prophylaxis (PrEP) for all persons at
high-risk in 2017 Following a WHO recommendation.
June, a
45-year-old sex worker in Mombasa and a mother of two teenage girls, takes her
Prep pills religiously.
“It’s also
because I have a longterm partner so I need to protect him as well. He knows
the work I do, and we agreed I need to protect him,” she told The Star.
NSDCC’s Mwanjama
said Mombasa has 54,361 residents living with HIV, Kenya’s seventh highest
number after Kisumu, Homa Bay, Migori, Siaya, Nairobi and Nakuru counties
respectively.
“As a major
port with international shipping links, Mombasa is susceptible to the
introduction of new HIV strains. This can lead to the emergence of complex HIV
recombinants,” he says.
“The HIV
epidemic in Mombasa exhibits both general and concentrated characteristics.
This means that the virus is spread throughout the general population, but also
within specific groups of individuals, such as key populations like female sex
workers.”
Mwanjama
explains that Prep does not protect against unintended pregnancies and
sexually transmitted infections.
“And that is why we encourage sex workers they must use condoms, which can
protect against all these risks,” he says.
Last year, Robert
Abuga of the County Government of Mombasa, and four other researchers, found
that married FSW and their life-partners are particularly vulnerable. They found that unprotected sex was higher
among married than unmarried FSWs, because married FSWs perceive themselves to
be at less risk.
Abuga’s
study also indicated that many FSWs are engaging in unprotected sex while under
influence of alcohol/drugs and having high frequency of sexual intercourse. Few
FSWs had tested for HIV within the last three months.
“Interventions
to address these modifiable factors such as creating FSWs’ social networks are
needed to control and prevent HIV among them,” the researchers advised.
“Social
networking among FSWs build peer solidarity/trust and may contribute greatly to
condom utilisation, which is one of the key interventions together with
pre-exposure prophylaxis used in the fight against HIV/Aids,” Abuga and
colleagues said in the study, published by the Pan African Medical Journal in April,
2024.
Prep pills
are part of the HIV commodities heavily financed by the US President’s
Emergency Plan for Aids Relief (Pepfar).
HIV prevention
and treatment services in Kenya are now at risk if the US makes good its plan
to completely cut funding.
Experts
said that makes prevention of HIV a top priority. Kenyans are still accessing
free Prep pills courtesy of a 90-day waiver that Usaid issued in February, to ensure
that life-saving HIV services, including treatment and prevention, can continue
for vulnerable populations.
Pepfar’s
annual contribution to Kenya’s HIV services, including ARVs and drugs such as
Prep, is Sh8 billion.
The Council
of Governors, NSDCC, National AIDS and STIS Control Programme, Kenya Medical
Supplies Authority have already appealed to the Kenyan government to plug in
the gap in case the US pulls out completely.
These
organisations especially made a strong case for HIV prevention services, which help
prevent a rise in Kenya’s HIV burden. People with HIV must take ARVs for life,
but Prep is not taken for life.
“For now we
still have enough Prep drugs in hospitals,” said Mwanjama.
Fatuma is
now in second year at the university and has resumed taking Prep. “I am doing
it for myself, my dreams, and my daughter,” she said.