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PrEP in Sri Lanka: Curbing the Spread of HIV

2022 May 18

Understanding HIV

The Human Immunodeficiency Virus is a virus that attacks our body’s immune system and can lead to AIDS (Acquired Immunodeficiency Syndrome). It can eventually lead to a person’s death in 8 to 10 years, caused by the variant HIV-1. HIV-2 is a non-progressive virus that doesn’t infect humans, and it is, in fact, naturally dying out within people. HIV-1, or HIV, has very few flu-like symptoms, majority of the time. Its high mutation rate also means that there are still no vaccinations against this virus.

HIV most commonly spreads through sexual transmission, as tissue abrasion occurs during sex. Once these abrasions arise, the virus can spread from one person to another. While anyone can contract HIV, it has shown a higher prevalence in men who engage in sexual intercourse with other men and transgender men and women. It is also possible for the virus to spread through the sharing of infected injections, as is most often the case with drug injection. The latter, while there are fewer cases, poses the highest risk of transmission.

Currently, Sri Lanka is considered a “low prevalence” country for HIV, with about 3,600 active cases and less than 200 new cases each year. The new infection rate is deemed flatlined, and this information is available through the National STD/AIDS Control Programme’s annual report from 2019.

Hence, it is important to note that contracting HIV does not automatically mean that your lifestyle is adversely affected or that you need to become a social outcast. While HIV is not curable, with treatment, anyone who acquired the virus, can suppress it to the point that it is undetectable, and most importantly, non-transmissible. This means that you can lead full and healthy lives without worrying about transmitting it to anyone else. Despite this, Sri Lankans who have acquired HIV are often stigmatised and even critically viewed as being reckless in their lifestyle choices. More often than not, ignorance and lack of awareness surrounding this topic are what prevent this topic from being discussed openly.

Getting to Know is PrEP for HIV?

Pre-Exposure Prophylaxis or PrEP is a tablet that combines two-drug regimens into one table. It can be taken by anyone who is HIV negative to ensure that they do not acquire HIV from their sexual partner. PrEP is expected to be taken daily based on your lifestyle choice. You can start taking it anytime when you feel that you are at risk of being exposed to HIV, and you can simply stop taking PrEP at any time when you feel that it is no longer needed.

PrEP can also be consumed as a 2-1-1 dosage, where you take a double doses 2 to 24 hours before sex, then a single dose after the initial dosage, and another single dose 48 hours after the initial dose. This is recommended only for men who have sex with men as the drug gets metabolised differently in men, women and transgender men or women.

PrEP has proven itself through many trials and decades of testing, to be extremely effective at preventing the spread of HIV. PrEP can boast of a 99% success rate in preventing sexual transmission. Its effectiveness in preventing transmission through injection is less studied, but it still was over 50% effective, as per these limited studies.

The PrEP drug regimen is also one that has very few side effects. Some people had reported that PrEP caused their stomach to be agitated during the initial stages. But these symptoms naturally fade away as you continue taking the drug. There is also a low possibility of the drug having a negative effect on a person’s kidney. Further, in a few clinical trials, some people taking PrEP have noted a slight decline in bone mineral density. However, this was in a clinically insignificant sample, and there was no real danger from this decline of bone mineral.

Getting on PrEP

It is important to note that PrEP is not an over-the-counter medication. A doctor’s prescription is required before you can take PrEP, and a prescription is usually given for 1 to 3 months. A prescription is needed because, before you can start taking PrEP, it is important to get tested for HIV and test your kidney function to make sure that PrEP is safe for consumption. Also, given that one of the drugs used in PrEP is used for the treatment of Hepatitis-B as well, a Hepatitis-B test will be done.

Additionally, PrEP is still not available through general pharmacies or medical clinics. PrEP in Sri Lanka is being given freely through the National STD/AIDS Control Programme, at 4 initial STD Clinics. These clinics are at the National STD/AIDS Control Programme in Colombo 10, the Teaching Hospital in Anuradhapura, the General Hospital in Hambantota and the Teaching Hospital in Ragama. By visiting any of these clinics, you can have your preliminary tests done and collect your prescriptions, free of charge. These four clinics are the pilot clinics, and PrEP will be available in other STD Clinics around Sri Lanka in the future. There are also plans to make PrEP available through pharmacies and community clinics as well.

For more information, visit the National STD/AIDS Control Programme website www.aidscontrol.gov.lk and book an online appointment to get tested for HIV in Colombo through www.know4sure.lk.

With PrEP, you can now feel safer, happier and lead a healthier sex life. We as a community can take some hopeful steps towards better understanding HIV to eradicate stigma around it, and the people who have contracted it.