Young women face scorn from their families over use of PrEP

Ordinarily, family members and romantic partners are the pillars of support when someone enters uncharted waters or takes a big life decision. But a new study among teenage girls and young women who take HIV pre-exposure prophylaxis (PrEP) suggests this is not always the case.

According to the research by the Desmond Tutu HIV Centre and the University of California, disclosure of PrEP use to loved ones can either be a facilitator or barrier.

Some of the women faced so much judgment and stigma over their daily pill that they stopped taking it, exposing themselves to HIV infection.

Speaking about her partner, a 19-year-old said: “He had this idea that if I took the pills, I would have multiple partners because I would be safe from getting HIV.

“It was more or less trust issues ... he kept on pushing me to stop taking the pills, but I wouldn’t.”

A teenage girl who was part of the study said: “My mother would always tell me that she doesn’t like what we are doing, because she feels that it’s inviting sickness. We are taking pills every day like we are sick.”

Another participant said if she took her pill while there was a visitor in the house, “my mother would tell that person I am taking pills for Aids”.

Writing in PLOS One, researchers noted that while most (84%) parents and partners are supportive, resulting in good adherence of PrEP, those who lack support are likely to stop taking the pills.

Even though many participants disclosed their PrEP use to mothers, fathers were  described as more approachable and often encouraged their daughters to take the daily pill.  

“I explained to my father ... and I told him that I joined that study, so I am taking the pill,” said a 17-year-old. “He said, ‘that is great, my daughter’.”

Another participant, aged 21, explained: “My dad has HIV. That’s why he pushed me. He is supporting me to do all this.”

However, daily PrEP pills may soon be a thing of the past, with a number of new long-acting prevention innovations  in the pipeline.

Speaking at the virtual Conference on Retroviruses and Opportunistic Infections (CROI) this week, Prof Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre, said while oral PrEP remains robust in preventing HIV infection, it is not feasible for everyone due to poor adherence.

“A solution to this is less frequent dosing with alternative types of agents, specifically longer-acting formulations,” she said.

Scientists were gaining lessons from contraceptives and antipsychotic long-acting innovations that had been working effectively and had improved adherence to treatment.

Some of the long-acting PrEP innovations in development, which Bekker called “superheroes of prevention”, include vaginal rings, monthly injections, implants, monthly pills and passive immunisation through the infusion of broadly neutralising antibodies (BNabs).

One of the new monthly injections, cabotegravir, is not only safe but was found to be superior to the tablet form, Truvada.

Prof Francois Venter, head of Ezintsha, a research group at Wits University, said as the country awaits the arrival of the new drug in the next few years, the health-care system needed to be scaled-up to ensure that it can cope and deliver the service.

He warned, though, that an injectable PrEP is not going to be a silver bullet in HIV prevention.

Operationally, delivering long-acting PrEP would be a complicated intervention, he said, and plans to use private pharmacies as injection sites were already being explored.

“We are trying to think about injection sites, which are outside clinical environment, looking to local pharmacies and points where injections can be administered,” said Venter.

“I think we’ve got little time to start playing with these models as registration is going to take a while before it gets to us. But that doesn’t mean that we should not start thinking about it ... the cold chain.

“We anticipate that they will be a little bit more expensive than oral preparations. Our information systems will have to be a little bit more rigorous.”

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