14 July 2014

Africa: WHO Recommends ARVs to Prevent HIV in Men Who Have Sex With Men

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Men who have sex with men (MSM) should be offered antiretrovirals (ARVs) before they contract HIV to prevent infection, according to new international guidelines released Friday.

The World Health Organisation's (WHO) new guidelines are aimed at stemming new HIV infections in five high risk groups, including MSM, injecting drug users, prisoners and sex workers.

The WHO recommends that HIV-negative MSM be offered either the ARV tenofovir, or a fixed dose combination of tenofovir and emtricitabine to prevent HIV infection, alongside condoms.

Often known by the brand name Truvada, a combination of tenofovir and emtricitabine is already included in South Africa's ARV tender to treat HIV. It is not however yet registered for use to prevent HIV.

According to the WHO, the inability to negotiate safe sex and high levels of stigma are just some of the factors putting these groups at a higher risk of contracting the virus.

Globally, about half of all new HIV infections occur among at risk populations, which also include transgender people, or people who do not identify with the sexuality they were born with.

Truvada is not registered in South Africa for HIV prevention, which precludes the Department of Health from rolling it out.

Cape Town's Dr Kevin Rebe was one of several South Africans that helped develop the new WHO guidelines. Rebe works with the Anova Health Institute's Health4Men project, which runs MSM-friendly clinics in Johannesburg and Khayelitsha.

"Truvada is not registered in South Africa for the indication of HIV prevention - only for HIV treatment," Rebe told Health-e News. "This precludes the Department of Health rolling out Truvada (to prevent HIV infection)."

"Registration needs to occur as a matter of urgency," said Rebe who added that until that happens, the country's conditional ARV grant will not fund the use of ARVs for prevention outside prevention of mother-to-child transmission programmes.

At about R90 per 28-pills, Truvada is on par with the country's three-in-one ARV, according to Medicines Sans Frontieres' Access Campaign Advocacy Officer Julia Hill.

The WHO's latest guidelines also continue to recommend daily doses of Truvada for HIV-negative people with stable HIV-positive partners but doctors caution that anyone taking Truvada to prevent HIV infection will have to be regularly monitored. People who contract HIV should be switched to a triple combination of ARVs to avoid developing resistance.

New WHO guidelines also now recommend that people who are likely to witness morphine or heroin overdoses - including fellow drug users - should be trained to administer life-saving naloxone injections in case of overdoses.

As of late last year. no such programmes are available in South Africa, according to Bronwyn Myers, chief specialist scientist at the Medical Research Council's Alcohol and Drug Unit.

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