NAMIBIA has advised its citizens against the use of Truvada, the drug reported to prevent HIV infection which the United States Food and Drug Administration (FDA) approved in the United States on Monday.
The decision of the US FDA is based on their review of results from recent clinical trials which have found that a daily oral dose of this drug, when taken as prescribed by people who do not have the virus, provided significant prevention benefit.
The Deputy Permanent Secretary in the Ministry of Health and Social Services, Dr Norbert Forster, yesterday told The Namibian that his ministry is looking into the drug, but only at policy level.
"No definite conclusion has been decided upon yet. Our prevention group is looking at the drug and assessing studies, but only at a policy level for now," he said.
Forster adds that although the drug was approved for use among sexually active adult men and women in the US, it still has a lot of "buts".
"At this stage, the research is mixed and there are still a lot of reservations out there. In any case, the maximum protection Truvada can give to users is a 73 per cent and not 100 per cent," he said.
The British Broadcasting Corporation yesterday quoted the FDA as saying Truvada "can be used by those at high risk of infection and anyone who may engage in sexual activity with HIV-infected partners".
Forster in addition said the drug is recommended for use by couples where one partner is HIV positive and the other not.
"The partner who is negative is the one to take the drug to prevent him/her from getting infected with the HIV virus. We advise against it at this stage because of the fact that in any case you will still need to use a condom and make sure that your partner is still on treatment," he said.
In a statement, the FDA also stressed that the drug should be used as part of a "comprehensive HIV prevention plan", including condom use and regular HIV testing.
"There have been concerns the circulation of such a drug could engender a false sense of security and people will take more risks. There have also been fears that a drug-resistant strain of HIV could develop," the BBC report said.
The Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) told The Namibian it welcomes the decision of the FDA to approve the use of Truvada to prevent the sexual transmission of HIV for people who do not have HIV, but who are at high risk of being exposed to the virus.
"Whilst this must be seen as a significant breakthrough in HIV prevention, the use of Truvada for pre-exposure prophylaxis is not a magic bullet and must be seen in the context in which we find ourselves in Namibia and in the region. Although costs have come down over the years, antiretroviral drugs used for the treatment of HIV are expensive," said Arasa director Michaela Clayton.
Clayton adds that even in Namibia where antiretroviral coverage is high compared to other countries in the region, there are still people living with HIV who need antiretroviral treatment yet do not have access to it and the cost of the drugs is not the only reason for this.
"Stigma and discrimination on the basis of HIV status remains unacceptably high and for this reason many people who suspect that they may be living with HIV are reluctant to have an HIV test and thus access the treatment that they need as they fear the treatment that they may receive at the hands of spouses or partners, family and community members and employers should their HIV status become known," she said.
In addition, Clayton said that gender inequality means that many women in Namibia are not able to enforce the use of condoms, which places them at greater risk of HIV infection.
"Existing laws that criminalise same-sex sexual relations and sex work make it extremely difficult for men who have sex with men and sex workers to access HIV prevention and treatment services, thus placing them at greater risk of HIV infection and compromising their ability to access HIV treatment if they need it," she said.
The advisory group of health experts apparently recommended approval for the pill in May.
Truvada, which is made by California-based Gilead Sciences, is already backed by the FDA to be taken with existing antiretroviral drugs for people who have HIV.
Studies from 2010 showed that Truvada reduced the risk of HIV in healthy gay men, and among HIV-negative heterosexual partners of HIV positive people by between 44 per cent and 73 per cent.
Michael Barton of the Joint United Nations Programme on HIV-AIDS is quoted by the BBC as saying that "there was good trial evidence that the drug could significantly cut the risk of the infection being passed on, but only if the tablets are taken consistently."
Truvada, states the BBC, is approved in the United Kingdom for the treatment of HIV, but not prevention.